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MODERN  BONESETTING 

FOR  THE 

MEDICAL  PROFESSION 


BY 


FRANK    ROMER, 

M.R.C.S.  Eng.,    L.R.C.P.  Lond. 


Surgeon  London  Guarantee  &  Accident  Co. 

Hon.  Surg.  Royal  Academy  of  Music 
Hon.  Surg.  Booksellers'  Benevolent  Society 


NEW    YORK 

REBMAN     COMPANY 

Herald    Square    Building 
141-145   West   36th   Street 


jr/v 


All  rights  reserved 

.     - 


INTRODUCTORY 


For  some  years  past  much  criticism  has  been  published 
by  the  lay  papers  on  the  after  treatment  of  bone  and 
joint  injuries  by  our  profession.  Owing  to  our  neglect 
of  the  so-called  art  of  bonesetting  many  such  cases  drift 
into  the  hands  of  the  unqualified  practitioner.  About 
four  years  ago,  in  reply  to  one  of  these  attacks, 
my  friend  Mr.  Creasy  and  myself  brought  out  in  book 
form,  under  the  title  of  "  Bonesetting  and  the  Treat- 
ment of  Painful  Joints,"  a  series  of  papers  which 
had  originally  appeared  in  the  Lancet  and  British 
Medical  Journal.  Brief  directions  were  given  in  this 
brochure  for  carrying  out  either  by  manipulation  or 
the  electric  wave  current,  a  form  of  treatment  we  had 
found  useful  in  cases  where  recovery  from  the  effects  of 
injury  was  slow  or  imperfect.  In  the  present  book  the 
treatment  by  manipulation,  or  "  Bonesetting "  as  it  is 
commonly  termed,  is  alone  considered,  and  in  addition  to 
the  description  of  the  movements,  illustrations  are  given 
showing  the  different  grips,  which  are  identical  with 
those  employed  by  our  unqualified  rivals.  At  the  com- 
mencement there  is  a  short  account  of  the  history  of 
Bonesetting,  and  an  endeavour  is  made  to  show  its 
influence  on  the  medical  profession  with  regard  to  their 
treatment  of  recent  injuries.  In  submitting  this  book  to 
the  consideration  of  my  professional  brethren  I  would 
like  to  say  that  it  is  written  with  the  object  of  drawing 
attention  to  a  line  of  work,  which,  if  the  principles  were 
more  thoroughly  mastered,  should,  from  its  simplicity, 
prove  useful  to  those  engaged  in  the  duties  of  private 
practice. 

The  question  occasionally  arises  as  to  the  probable 
origin  of  this  humble  branch  of  surgery.     Dr.  Wharton 


viii  INTRODUCTORY 

Hood,  to  whom  the  profession  were  originally  indebted 
for  the  elucidation  of  the  bonesetters'  secrets,  held  the 
opinion  that  "  the  first  bonesetter  was  the  servant  or  the 
unqualified  assistant  of  a  surgeon  who  had  known  exactly 
what  could  be  done  by  sudden  movements  and  how  the 
movements  should  be  executed."  This  theory  is  of 
course  possible,  but  Waterton,  the  naturalist,  points  out 
that  this  "art"  is  practised  not  only  in  England  but 
throughout  Europe  as  well,  and  that  in  Spain  he  bears 
"the  significant  name  of  Algebusta."  Personally,  I 
believe  that  some  such  rough  and  ready  method  of 
treatment  has  always  existed,  but  that  its  utility  got 
overlooked  during  the  time  surgery  was  developing  into 
a  definite  science.  As  our  professional  ancestors  pro- 
gressed in  their  knowledge  of  pathology,  such  a  condition 
as  tubercular  disease  began  to  be  more  generally  under- 
stood, and  the  importance  of  quietude  in  this  and  other 
acutely  inflamed  joints  was  soon  realized.  In  con- 
sequence of  the  general  appreciation  of  the  value  of 
absolute  physiological  rest  in  these  cases,  it  was  not  long 
before  it  was  considered  essential  for  the  treatment  of 
all  painful  and  swollen  joints,  no  matter  from  what 
cause.  The  cult  of  complete  rest  became  to  be  deemed 
so  necessary  that  it  was  never  considered  advisable  to 
use  a  joint  as  long  as  the  least  pain  was  experienced 
on  attempted  movement,  thereby  reminding  one  of  the 
boy  who  was  forbidden  to  enter  the  water  till  he  had 
learned  to  swim. 

The  universal  adoption  of  these  principles  by  the 
profession  caused  anything  in  the  way  of  more  vigorous 
treatment  of  injuries  to  remain  in  the  hands  of  the  less 
educated  classes,  who,  rushing  in  "  where  angels  fear  to 
tread,"  frequently  obtained  brilliant  results  from  their 
unorthodox  methods.  Thus  it  happened  that  many  of 
the  vendors  of  herbs  and  simples  resident  in  country 
places  came  to  specialize  in  this  business,  which,  unlike 
the  majority  of  folk  lore  remedies,  contained,  in  the 
words  of  the  Lancet,  "  some  long  forgotten  truth."     Mr. 


INTRODUCTORY  ix 

Bennett,  a  well-known  bonesetter  from  the  Midlands, 
wrote  a  book  in  1880,  to  which  I  am  indebted  for  some 
interesting  historical  information.  Unfortunately,  beyond 
acquiescing  in  the  correctness  of  the  movements  detailed 
by  Dr.  Wharton  Hood,  he  gives  no  hints  as  to  his  own 
procedure.  He  does,  however,  lay  claim  to  treating 
recent  dislocations  and  fractures  as  well  as  the  old- 
standing  cases  of  impaired  limbs.  As  far  as  I  can  find 
out  no  other  bonesetter  has  ever  committed  his  methods 
and  experiences  to  paper,  though  I  understand  that  in 
America  certain  books  are  published  on  Osteopathy, 
which  is  apparently  a  glorified  form  of  the  old-fashioned 
bonesetting.  The  methods  employed  by  Hutton  were 
fully  explained  by  Dr.  Wharton  Hood  in  his  book,  and 
though  those  I  am  about  to  describe  are  practically  the 
same  there  is  occasionally  some  deviation  ;  attention  is 
also  drawn  to  the  particulars  of  the  after  treatment, 
which  is  most  important  in  cases  treated  in  this  way. 
There  is  still  something  to  be  gleaned  from  the  pro- 
cedure of  the  modern  Huttons  in  spite  of  our  increased 
knowledge  of  the  subject,  and  I  counsel  my  profession  to 
bear  in  mind  to-day  the  advice  given  by  Sir  James  Paget 
many  years  ago,  "  to  copy  what  is  good  in  the  practice  of 
bonesetters."  During  my  student  days,  though  we  were 
taught  the  pathology  of  adhesions  and  the  possibility  of 
their  appearance  in  joints  after  injury,  beyond  the  fact 
that  the  ensuing  disability  could  be  remedied  by 
"breaking  down,"  no  instruction  or  information  was 
vouchsafed  as  to  the  best  way  for  setting  about  the  act. 
Dr.  Wharton  Hood,  to  whom  I  am  ever  under  a  great 
debt  of  gratitude  for  many  acts  of  kindness,  first 
showed  me  what  good  results  could  be  obtained  by 
forcible  movements  skilfully  applied  in  suitable  cases. 

Well  known  authorities  in  orthopaedic  surgery,  such 
as  Mr.  Howard  Marsh  and  Mr.  Tubby,  have  described 
the  procedure  to  be  followed  when  dealing  with  cases 
in  which  treatment  by  brisement  force  is  considered 
desirable.     Mr.   Tubby,    when    describing    contractures 


x  INTRODUCTORY 

and  ankylosis  in  his  book  on  "  Deformities,  a  treatise 
on  Orthopaedic  Surgery,"  says  that  in  regard  to  the 
prognosis  of  such  conditions  : — "  This  may  be  best 
determined  in  the  case  of  fibrous  ankylosis  by  an 
examination  under  an  anaesthetic.  If,  with  the  employ- 
ment of  very  slight  force,  the  adhesions  readily  give  way, 
and  but  little  heat,  pain  or  swelling  follow,  then  a  good 
result  may  be  looked  for  when  passive  motion,  douching 
and  massage  are  persevered  with.  But  it  is  not  the 
remotest  use  breaking  down  adhesions  once  and  then 
sending  the  patient  away.  Passive  motion  must  be 
employed  within  a  day  or  two  of  the  operation  and 
steadily  continued  ;  thus  only  can  a  successful  result  be 
obtained." 

Continuing,  he  finds  that  "  preliminary  tenotomy  and 
fasciotomy  are  often  of  service."  It  might  be  assumed 
from  these  words  that  forcible  manipulation  was  only 
really  necessary  in  the  more  obvious  and  severe  cases  of 
ankylosed  joints,  and  yet  Mr.  Tubby  remarks  : — "  In 
many  instances  some  amount  of  fibrous  ankylosis  is  due 
to  unwillingness  on  the  part  of  the  patient  to  move  the 
joint  after  a  slight  attack  of  synovitis,  or  to  want  of 
firmness  on  the  part  of  the  medical  attendant  in  insisting 
on  the  patient  so  doing.  Particularly  is  this  the  case  in 
some  cases  of  severe  sprain  and  in  inflammation  of  a  joint 
associated  with  fracture  in  the  neighbourhood.  Such 
cases  drift  about  until  they  fall  into  the  hands  of  the 
bonesetter,  who,  with  one  jerk,  relieves  the  patient  of 
his  or  her  disability  and  arrogates  to  himself  the  credit 
of  •  putting  in  a  dislocated  bone.'  " 

The  advisability  of  the  medical  man  in  charge  of  such 
patients  performing  this  small  operation  himself  is  not, 
however,  suggested.  The  number  of  patients  suffering 
in  the  way  just  described,  who  attend  the  consulting 
rooms  of  the  unqualified  practitioners,  is  far  greater  than 
is  generally  supposed,  and  the  incomes  earned  in 
consequence  by  some  of  the  London  bonesetters  would 
be  a  revelation  to  the  medical  profession.     One  of  the 


INTRODUCTORY  xi 

best  known  amongst  them  informed  me  that  he  was 
occupied  all  day,  and  every  day,  treating  the  various 
forms  of  defective  joints.  It  is  obvious,  therefore,  that 
our  profession  are,  to  a  certain  extent,  either  chary  of 
trying  this  simple  form  of  treatment  for  themselves,  or 
are  ignorant  of  the  benefit  to  be  obtained  by  its 
adoption,  especially  in  those  vague  conditions  of  impaired 
mobility  where  the  patient  complains  more  of  a  deviation 
from  the  normal  than  of  anything  markedly  defective. 
Granted,  that  certain  of  these  cases  are  quite  trivially 
affected  and  might  almost  come  under  the  heading  of 
hysterical  joints,  yet,  if  free  movement  under  an  anaes- 
thetic affords  the  welcome  relief,  either  by  suggestion  or 
the  freeing  of  some  small  adhesions,  the  result  is  bene- 
ficial, and  such  treatment  is  worthy  of  more  attention 
than  it  at  present  receives.  In  describing,  therefore,  the 
different  manipulations  suitable  for  joints  where  marked 
impairment  is  present,  attention  is  drawn  to  the  slighter 
disabilities  capable  of  being  cured  by  the  same  means, 
and  in  which  the  bonesetter  of  to-day  specializes. 

Contrary  to  the  popular  belief  that  some  mysterious 
gift  is  essential  for  the  successful  performance  of  these 
manipulations,  there  is  nothing  to  prevent  any  practi- 
tioner doing  them  with  success,  provided  that  care  is 
taken  to  ascertain  the  particular  lesion  that  exists.  A 
certain  delicacy  of  touch  is  doubtlessly  requisite  to 
properly  appreciate  that  lesion,  whilst  the  correction 
largely  depends  on  knack,  but  both  can  easily  be 
acquired  by  experience  and  practice. 


CONTENTS 


Chapter  I. 


Chapter  II. 


Chapter  III. 


History  of  Bonesetting 


Principles  of  Bonesetting 


Manipulations 


TAGE. 

I 


12 


22 


Chapter  IV.  Exercises  in  After  Treatment  47 

Chapter  V.  Notes  on  Cases  5j 


EXPLANATION  OF  PHOTOGRAPHS 


i.  Hand  grasp  for  lateral  and  circumductory  move- 
ments OF  WRIST. 

2.  Hold  for  flexion  and  extension  of  wrist. 

3.  Hold  at  completion   of   flexion    of    elbow    joint 

and  preparatory  to  extension. 

4.  Hold    during    extension    of    elbow — note    thumb 

pressure  over  head  of  radius. 

5.  Rotation   of  head   of   humerus  with   right    hand, 

left  hand  holding  the  joint. 

6.  Hand  slid  up  for  short  lever,  bringing  arm  across 

the  chest. 

7.  Right  hand  pushing  against  scapula  during  abduc- 

tion OF  ARM. 

8.  Arm  having  been  rotated  outwards,  is  now  brought 

up  above  level  of  head. 

9.  Placing  arm   behind  the   back — note    left   thumb 

pressed  over  head  of  biceps. 

10.  Grasp    of    hands    for    knee    joint,    patient's   foot 

between  operator's  thighs. 

11.  Flexion  of  knee  joint    by    bending   of  operator's 

KNEES. 

12.  Flexion  of  hip  joint  in  traumatic   lumbago — left 

hand  steadying  the  pelvis. 

13.  Both  thighs  flexed  and  pushed  on  to  chest  wall. 

14.  Completion  of  thrust  back  for  extension  of  spine 

by   the  right   hand — the   left   hand   pressing 
acting  as  the  fulcrum. 

15.  Grip   of   the    foot    in   tarso-metatarsal   adhesions 

— note  position  of  right  thumb. 

16.  Position    of    patient    in    posture     exercises    for 

voluntary  stretching  of  shoulder. 

17.  First   position    of    posture    exercise    for    bending 

knee  joint. 

18.  Second  Position. 


CHAPTER   I 

HISTORY    OF    BONESETTING 

The  general  public  have  always  shewn  themselves 
greatly  interested  in  the  cures  achieved  by  the  so- 
called  art  of  bonesetting  as  practised  by  its  expo- 
nents. Doubtless  this  is  in  some  measure  due  to 
an  inherent  belief  in  all  "occult"  methods  of 
treatment,  together  with  the  mistaken  notion  that 
only  certain  individuals  are  endowed  with  some 
peculiar  gift  of  healing  by  manipulation.  At  the 
same  time  credibility  alone  would  not  be  sufficient 
to  keep  interest  alive,  were  it  not  founded  on  some- 
thing more  definite  ;  and  it  must  be  granted  that 
treatment  at  the  hands  of  unqualified  practitioners 
often  brings  about  quick  and  permanent  cure,  even 
in  cases  where  the  highest  surgical  skill  has  been 
sought  in  vain. 

That  well-known  surgeon,  the  late  Sir  James 
Paget,  in  a  lecture  delivered  by  him  at  St.  Bartholo- 
mew's Hospital,  made  the  following  observation: — 
"  Few  of  you  are  likely  to  practise  without  having 
a  bonesetter  for  an  enemy,  and  if  he  can  cure  a 
case  which  you  have  failed  to  cure,  his  fortune  may 
be    made    and   yours   marred."      These   words    I 


2  HISTORY  OF  BONESETTING 

venture  to  say  are  as  true  to-day  as  they  were  some 
forty  odd  years  ago.  In  spite  of  our  increased 
knowledge  in  what  the  Lancet  once  termed  "  that 
long  neglected  corner  of  the  domain  of  surgery," 
modern  professors  of  bonesetting  are  doing  as  much 
to  lower  the  reputation  of  the  present  generation 
of  medical  men  in  the  eyes  of  the  public  as  their 
prototypes,  made  famous  by  Hutton,  managed  to 
do  to  their  fathers  before  them,  in  regard  to  the 
treatment  of  injured  joints. 

Though  this  statement  may  possibly  give  rise  to 
difference  of  opinion,  yet  judging  from  the  letters 
in  the  public  press  that  periodically  appear  in  the 
ever  recurring  controversy  on  bonesetting,  as  well 
as  my  own  experience  in  the  subject,  I  am  con- 
vinced that  the  medical  practitioner  pays  but  scant 
heed  to  this  particular  branch  of  work,  and  is,  with 
but  few  exceptions,  quite  uninformed  as  to  the  class 
of  case  suitable  for  treatment  by  manipulation  or 
to  the  methods  best  adapted  for  the  purpose.  The 
reason  that  such  a  condition  of  affairs  should  exist 
bears  this  explanation.  The  modern  treatment  of 
bone  and  bone  joint  injuries  by  means  of  massage, 
radiant  heat  or  electricity,  in  the  place  of  the 
absolute  and  physiological  rest  formerly  deemed 
essential,  has  made  it  comparatively  rare  to  find  a 
joint  entirely  incapacitated  by  fibrous  adhesions. 

In  certain  cases,  such  as  fracture  in  close  prox- 
imity to  a  joint,  this  condition  of  complete  ankylosis 


HISTORY  OF  BONESETTING  3 

may  and  does  sometimes  occur,  but  being  readily 
recognized,  the  surgeon  would  speedily  rectify  the 
loss  of  mobility  before  relinquishing  attendance. 
In  truth  most  medical  men  understand  and  success- 
fully deal  with  the  grosser  lesions  caused  by 
adhesions,  but  it  is  particularly  in  the  smaller 
defects  that  their  observation  fails.  Just  as  the 
majority  of  surgeons  fifty  years  ago  closed  their 
eyes  to  the  lessons  being  taught  by  Hutton, 
Matthews,  Mason  and  a  host  of  less  well  known 
bonesetters  who  were  competently  and  constantly 
treating  the  old-fashioned  rigid  joint,  so  the  modern 
practitioner  is  apt  to  look  askance  at  the  work  of 
the  present  day  bonesetter,  who  has  adapted  his 
treatment  to  the  conditions  existing  where  the 
utility  of  a  joint  is  slightly  impaired  by  some  defect 
which  though  not  sufficient  to  cause  complete  lack 
of  movement  yet  is  capable  of  being  both  irksome 
and  painful.  The  old  idea,  that  these  cures 
wrought  by  bonesetters  are  brought  about  by  the 
reduction  of  an  overlooked  dislocation,  still  holds 
good  in  the  public  mind.  This  historical  diagnosis 
of  "  Bone  out "  may  be  accounted  for  by  the  fact 
that  these  men,  being  for  the  most  part  totally 
ignorant  of  the  true  nature  of  the  lesion,  were 
misled  by  the  crack  of  the  rupturing  adhesions,  and, 
finding  that  improved  mobility  followed  their  mini- 
strations, were  honestly  convinced  that  a  bone  had 
been  restored  to  its  place.     Many  of  the  bone- 


4  HISTORY  OF  BONESETTING 

setting  fraternity  still  adhere  to  this  popular  error, 
though  it  is  but  fair  to  add  that  the  best  known  of 
them  holds  no  such  mistaken  view. 

Survival  of  this  incorrect  diagnosis  has,  I  believe, 
done  much  to  prevent  medical  men  enquiring  more 
fully  into  the  meaning  of  these  present  day  cures. 
Satisfied  that  no  marked  ankylosis  or  anatomical 
displacement  existed  in  some  case  treated  success- 
fully by  modern  bonesetting,  they  are  inclined  to 
dismiss  further  discussion  of  the  question.  On  the 
assumption  that  the  result  has  probably  been 
achieved  by  suggestion,  no  attempt  is  made  to 
connect  it  with  the  modern  aspect  of  old-fashioned 
bonesetting  of  which  they  are  already  well  in- 
formed. All  the  same,  from  the  patient's  point  of 
view  accurate  diagnosis  is  not  nearly  so  important 
as  successful  treatment.  It  is  only  human  that  the 
lay  mind  should  prefer  to  accept  the  opinion  of  the 
man  who  erroneously  states  a  "bone  is  out,"  and 
then  works  a  speedy  cure,  in  preference  to  believ- 
ing the  doctor  who  correctly  maintains  there  is 
nothing  anatomically  wrong  but  can  offer  no  other 
advice  than  that  time  will  probably  bring  about 
recovery. 

Doubtless  most  medical  men  have  themselves  at 
some  time  or  other  either  seen  or  are  aware  of 
instances  where  considerable  damage  and  even 
'atal  results  have  followed  the  manipulation  of 
joints   unsuited    for   such   treatment.     That   these 


HISTORY  OF  BONESETTING  5 

unfortunate  accidents  have  occurred  is  only  too 
true,  but  it  would  be  a  mistake  to  condemn  all 
treatment  by  bonesetting  on  this  account.  Such 
errors  would  rarely,  if  ever,  be  occasioned,  were 
medical  men,  with  their  skilled  training  and  the 
advantages  offered  nowadays  to  diagnosis  by  radio- 
graphy, to  take  the  trouble  to  acquire  the  technique 
of  bonesetting.  They  would  thus  enable  them- 
selves by  its  means  to  undertake  the  treatment  of 
those  cases  which  still  continue  to  stray  into 
unqualified  hands. 

A  greater  understanding  of  this  much  mis- 
understood line  of  work  would,  I  am  convinced, 
prove  of  the  utmost  value  in  two  ways  :  to  the 
public  at  large  by  protecting  them  from  the  risk 
of  faulty  diagnosis  and  to  the  medical  profession 
itself  by  removing  the  reproach  of  indifference, 
which  is  so  constantly,  and  I  fear  not  unjustly, 
made  with  regard  to  their  treatment  of  joints 
whose  recovery  from  injury  is  unduly  delayed. 

In  all  probability,  not  only  in  England  but  practic- 
ally all  over  the  world,  the  method  of  treating  injured 
limbs  by  what  is  called  bonesetting  has  always 
been  in  existence.  In  some  country  districts  the 
same  family  for  many  generations  past  has  had  one 
of  its  members  carrying  on  the  trade  of  bonesetter. 
The  different  movements  and  methods  of  procedure 
were  treated  as  business  secrets,  and  handed  down 
from   father    to    son   or   some  other  near  relative 


6  HISTORY  OF  BONESETTING 

who  might  show  aptitude  or  desire  to  take  up  the 
calling.  Nearly  all  the  present  day  bonesetters 
can  trace  a  relationship  to  a  former  exponent  of 
the  art,  and  in  many  cases  have  made  considerable 
advance  in  their  knowledge  of  the  treatment  their 
forefathers  taught.  Apart  from  the  fact  that  these 
men  looked  upon  their  knowledge  as  a  secret  to 
be  jealously  guarded  from  any  enquiries,  they  were 
usually  drawn  from  the  humbler  and  less  educated 
classes,  hence,  until  the  publication  of  some  papers 
"On  Bonesetting — So  called,"  by  Dr.  Wharton 
Hood,  in  1871,  no  literature  existed  on  the  subject. 
In  1665  we  find  that  a  man  named  Turner  pub- 
lished a  book  entitled  the  "  Compleat  Bonesetter,'' 
but  beyond  quaint  descriptions  of  certain  fractures 
no  information  regarding  manipulative  treatment  is 
given.  References  in  the  public  press,  however, 
were  not  uncommon,  and  the  London  Magazine, 
in  1736,  brings  into  considerable  prominence  the 
claims  of  a  certain  Mrs.  Mapp,  who  lived  at  Epsom. 
She  was  the  daughter  of  a  Wiltshire  bonesetter  and 
speedily  made  a  great  name  for  herself,  not  only 
at  Epsom  but  in  London  itself.  So  famous  did  she 
become  that  a  play  was  acted  at  Lincoln's  Inn 
Fields  entitled  "  The  Husband's  Relief  or  the 
Female  Bonesetter  and  the  Worm  Doctor,"  in 
which  reference  is  made  to  her  as  the  "doctress  of 
Epsom."  Scattered  through  the  various  periodicals 
and  magazines,  letters  and  articles  were  constantly 


HISTORY  OF  BONESETTING  7 

appearing  in  which  attention  was  drawn  to  the 
recoveries  brought  about  by  the  bonesetter,  and  to 
the  inability  of  the  medical  profession  either  to 
understand  or  explain  the  meaning  of  such  cures. 
The  numerous  writers  of  letters  to  the  newspapers 
of  to-day  on  this  same  subject  need  not,  therefore, 
imagine  they  are  propounding  a  novelty,  for  it 
would  appear  bonesetting  has  always  been  a  fruitful 
source  of  copy  to  journalism.  Some  of  these 
written  experiences,  though  lengthy,  make  interest- 
ing reading  enough ;  one  cannot  be  surprised, 
though,  that  the  medical  profession  failed  to  arrive 
at  the  truth  of  the  bonesetting  question,  concealed 
as  it  was  in  the  mass  of  verbosity  and  irrelevant 
detail  the  writers  adopted  when  describing  their 
cases. 

Curiously  enough  the  word  "bonesetter"  has  no 
connection  with  the  surgical  skill  necessary  to 
obtain  good  position  in  fractured  bones.  The 
origin  of  the  word  is  hard  to  find,  but  its  practice 
has  been  known  from  time  immemorial.  Dr. 
Wharton  Hood  defines  it  "  as  the  art  of  overcoming, 
by  sudden  flexion  or  extension,  any  impediment  to 
the  free  motion  of  joints  that  may  be  left  behind 
after  the  subsidence  of  the  early  symptoms  of 
disease  or  injury."  It  was  in  1871,  as  I  have 
mentioned,  that  Dr.  Wharton  Hood  published  in 
the  Lancet  a  series  of  papers  describing,  from  per- 
sonal observation,  the  methods  used  by  Hutton,  a 


8  HISTORY  OF  BONESETTING 

bonesetter  of  world-wide  reputation.  For  the  first 
time  the  real  meaning  of  these  mysterious  move- 
ments referred  to  by  so  many  patients  was  made  clear 
to  the  medical  profession.  The  question  of  bone- 
setting  at  once  received  considerable  attention  in 
medical  circles.  Papers  were  read  at  various  meet- 
ings on  the  subject,  when  it  received  full  discussion. 
Dr.  Bruce  Clarke  was  amongst  the  first  to 
describe,  from  the  dissection  on  the  joints  of 
amputated  limbs,  the  real  nature  of  the  adhesions 
which  caused  the  disability  capable  of  being  cured 
by  free  movements.  In  the  course  of  his  lecture 
he  advised  surgeons  to  consider  seriously  the 
question  as  to  whether  prolonged  rest  in  all  cases 
of  injury  was  absolutely  necessary,  since  it  un- 
doubtedly was  the  cause  of  these  adventitious  bands 
being  formed.  Some  years  previously  Sir  James 
Paget,  in  a  lecture,  "  Cases  which  Bonesetters 
Cure,"  had  given  similar  advice  by  saying,  "  Sprains 
may  often  be  quickly  cured,  freed  from  pain  and 
restored  to  useful  power  by  gradually  increased 
violence  of  rubbing  and  moving."  Dr.  Dacre  Fox, 
of  Manchester,  about  the  same  time  contributed 
an  interesting  article  pointing  out  that  the  bone- 
setters  in  the  North  did  not  entirely  confine  their 
work  to  the  treatment  of  old  injuries,  but  were 
constantly  employed  by  their  clients  for  recent 
sprains  and  dislocations,  which  they  treated  with 
marked  success. 


HISTORY  OF  BONESETTING  9 

In  fact  it  would  appear  that  these  men,  though 
possessing  no  training  in  surgical  or  anatomical 
knowledge,  were  in  the  habit  of  moving  and  rubbing 
recent  injuries  long  before  early  movement  and 
massage  was  deemed  a  correct  method  of  treat- 
ment by  the  medical  profession.  An  old  time 
Lancashire  bonesetter,  on  being  questioned  as  to 
his  reasons  for  treating  sprains  in  this  way,  replied, 
"What  has  been  caused  by  violence  must  be  cured 
by  violence."  From  this  epigramatic  remark  one 
might  almost  define  bonesetting  as  being  the 
homoeopathy  of  surgery,  since  "  similia  similibus 
curantur,"  best  describes  its  methods. 

The  movements  adopted  were  not,  as  some 
imagine,  merely  haphazard  in  direction  and  amount 
of  violence:  whether  employed  for  breaking  down 
adhesions,  moving  sprained  joints  or  reducing 
dislocations,  they  were  the  outcome  of  a  certain 
knowledge.  This  knowledge,  combined  with  con- 
stant practice,  observation  and  experience,  made 
the  bonesetters  conversant  with  the  situations  where 
adhesions  were  most  commonly  found  in  the 
different  joints,  and  I  think  it  quite  feasible  that, 
besides  the  carefully  studied  movements  used  by 
them  for  breaking  down  adhesions,  they  employed 
routine  manipulations  for  reducing  the  various 
dislocations,  much  on  the  same  lines  that  Kocher 
describes  in  his  method  for  the  reduction  of  a 
dislocated  humerus. 


io  HISTORY  OF  BONESETT1NG 

Dr.  Wharton  Hood,  Howard  Marsh  and  others, 
however,  consider  that  any  successful  treatment  of 
dislocations  at  the  hands  of  these  men  was  merely 
a  matter  of  luck.  On  the  other  hand,  Dr.  Schivardi, 
of  Milan,  in  1871  asserted  that  a  woman  named 
Regina  dal  Cin,  a  well  known  bonesetter  of  Trieste, 
not  only  broke  down  adhesions  by  methods  similar 
to  those  employed  by  Hutton,  but  successfully 
reduced  dislocations  as  well,  some  being  of  long 
standing.  She,  it  may  be  of  interest  to  note,  was 
the  daughter  of  a  bonesetter,  and  at  one  time 
received  permission  to  practice  at  Vienna,  though 
the  permit  was  eventually  withdrawn.  From  this 
time  onward  the  medical  profession  recognized  the 
benefits  to  be  derived  from  the  hitherto  despised 
practice  of  bonesetting.  Not  only  did  they  adopt 
similar  methods  for  the  correction  of  joints 
ankylosed  by  fibrous  adhesions,  but  by  modifying 
the  period  of  complete  rest  in  sprains  and  fractures 
they  lessened  the  chances  of  such  a  condition 
arising.  Gradually  the  employment  of  massage, 
heat  and  electricity  became  to  be  more  generally 
accepted  in  this  class  of  injury,  till  nowadays  it  is 
almost  universally  advised  as  affording  the  best 
results.  The  adoption  of  this  more  active  mode  of 
treating  injuries  has  had  the  curious  effect  of 
reviving  the  cult  of  the  bonesetter.  This  recru- 
descence may  he  attributed  to  the  following  causes. 
In   consequence  of  these   modern   methods,  prac- 


HISTORY  OF  BONESETTING  II 

titioners  have  had  less  necessity  or  opportunity  for 
breaking  down  adhesions,  and,  it  would  seem,  have 
apparently  forgotten  that  "  bonesetting "  might 
occasionally  prove  a  valuable  adjunct  to  treatment. 
In  addition,  relying  too  much  on  passive  move- 
ments and  the  endeavours  of  the  masseur  to  prevent 
the  formation  of  adhesions,  they  are  nowadays  too 
apt  to  prescribe  prolonged  massage  for  the  relief  of 
joints  where  recovery  from  the  results  of  trauma  is 
unduly  delayed.  Though  it  is  quite  possible  that 
perseverance  in  such  treatment  would  bring  about 
the  desired  effect,  yet  patients  are  often  inclined  to 
grudge  the  time  and  expense  it  entails,  the  result 
being  that  many  of  them  seek  and  find  relief  at  the 
hands  of  the  unqualified  bonesetter,  who  is  once 
more  enabled  to  flourish  in  our  midst. 


CHAPTER  II 

PRINCIPLES    OF    BONESETTING 

The  question  as  to  what  cases  are  suitable  for 
treatment  by  manipulation  depends  to  a  large 
extent  on  the  length  of  time  which  has  elapsed 
since  the  injury  was  originally  sustained,  for  though 
the  joint  impaired  by  such  conditions  as  rheumatism, 
the  so-called  rheumatoid  arthritis,  or  gonorrhceal 
infection  may  sometimes  be  benefited  by  similar 
methods,  yet  undoubtedly  it  is  where  recovery  from 
the  effects  of  trauma  is  slow  that  forcible  move- 
ment gives  the  best  results.  No  useful  object 
will  be  served  by  describing  the  pathology  of  the 
various  ankyloses,  and  for  the  purpose  of  this  book 
it  may  be  assumed  that  reference  is  made  to  fibrous 
adhesions  caused  mainly  by  trauma,  though  certain 
cases  may  be  included  where  ankylosis  has  been 
caused  through  other  conditions. 

Again,  though  treatment  by  bonesetting  is  usually 
rapid  and  effective,  it  must  be  remembered  that  a 
cure  could  in  many  cases  be  achieved  by  electricity, 
prolonged  massage  or  other  means.  In  certain 
persons  perfect  recovery  from  the  effects  of  some 
apparently  trivial  sprain  is  always  prolonged,  even 


PRINCIPLES  OF  BONESETTING  13 

though  a  course  of  treatment  has  been  adopted 
identical  in  all  respects  to  what  has  ordinarily  been 
found  sufficient  to  effect  speedy  recovery  in  more 
normal  patients.  For  this  reason  it  is  impossible 
to  give  any  definite  time  as  to  when  it  is  desirable 
to  interfere,  but  it  is  seldom,  save  in  certain  cases, 
necessary  to  do  so  till  some  four  or  five  weeks 
after  the  receipt  of  injury.  I  have  found  adhe- 
sions make  their  appearance  in  a  joint  as  early  as 
three  weeks  after  the  receipt  of  an  injury.  Their 
capability  of  interfering  with  the  action  of  a  joint 
depends  to  a  large  extent  on  their  situation.  They 
may  exist  within  the  joint  itself,  binding  together 
the  articular  surfaces  and  folds  of  the  synovial 
membranes  or  be  entirely  periarticular,  when  the 
surrounding  tendons  have  become  adherent  to  their 
sheaths  through  teno-synovitis.  The  resulting  dis- 
ability may  vary  from  complete  ankylosis  of  the  joint 
to  a  condition  where  pain  is  only  elicited  by  some 
particular  movement.  An  important  point  to  bear 
in  mind  is  that  a  joint  need  not  be  entirely  incapa- 
citated by  adhesions  to  be  benefited  by  manipula- 
tions. As  I  have  said  before,  complete  ankylosis 
is  rare  compared  to  what  it  was  in  the  time  when 
absolute  rest  was  considered  essential  in  the  treat- 
ment of  bone  and  joint  injuries.  Hence  it  frequently 
happens  that  the  possibility  of  some  small  adven- 
titious band  is  not  suspected,  provided  the  joint 
moves  with  comparative  freedom.     Though  doubt- 


14  PRINCIPLES   OF  BONESETTING 

less  all  medical  men  are  fully  aware  of  the  effect  of 
adhesions  on  a  joint,  and  the  methods  of  dealing 
with  them,  nevertheless  bonesetters  are  still  able 
to  gain  kudos  in  cases  in  which  some  minor 
disability  follows  the  orthodox  treatment.  The 
class  of  defective  joints  most  commonly  met  with 
as  being  suitable  for  this  treatment  are  : — 

i.     Joints    which    have   become  weak  and   stiff  from 
sprains. 

2.  Joints  adjacent  to  the  seat  of  a  fracture,  rendered 

stiff  and  useless  from  enforced  rest. 

3.  Cases  where  bones  entering  into  the  formation  of  a 

joint  have  sustained  injury,  though  the  amount  of 
disability  caused  by  alteration  in  the  position  of 
the  bones  may  accentuate  the  loss  of  the  full  range 
of  movement. 

4.  Those   stiff  from   disease,   such   as  rheumatism   or 

rheumatoid  arthritis. 

Nowadays,  though  the  cold,  cedematous  appear- 
ance of  a  joint  incapacitated  in  this  manner  is  no 
longer  so  marked,  the  situations  where  the  adhesions 
form  and  the  pain  is  experienced  are  practically  the 
same,  and  I  cannot  do  better  than  enumerate  the 
usual  sites  of  these  painful  spots,  as  pointed  out  by 
Dr.  Wharton  Hood  and  Dr.  Dacre  Fox : — 

1.  Over  the  head  of  the  femur  in  the  centre  of  the 

groin,  corresponding  to  the  ilio  femoral  band  of 
the  capsular  ligament. 

2.  For  the  knee  joint,  at  the  back  of  the  lower  edge  of 

the  internal  condyle.  In  other  words  at  the 
posterior  border  of  the  interior  lateral  ligament, 
where  the  semi-membranosus  tendon  is  in 
intimate  relation  with  it.     This  part  suffers  most 


PRINCIPLES  OF  BONESETTING  15 

because  a  sprained  knee  is  almost  always  caused 
by  the  joint  yielding  on  the  inner  aspect. 

3.  In  the  shoulder,  at  the  point  corresponding  to  the 

bicipital  groove,  the  posterior  and  inferior  folds  of 
the  capsular  ligament  and  the  side  of  the  joint 
corresponding  to  the  bursa  of  the  deltoid,  which 
sometimes  becomes  adhesive  through  inflammation 
of  the  surrounding  tissues. 

4.  The  elbow  :    the  front   of  the   tip  of   the  internal 

condyle.     The  fan-shaped  internal  lateral  ligament 

has  its  apex  at  that  point,  and  it  is  most  stretched 

in  over-supination,  with  extreme  extension  of  the 

forearm. 

On  the  front  of  the  external  malleolus,  the  apex  of 

the  plantar  arch,   the  tip    of  the   fifth   metatarsal 

bone,  the  styloid  process  of  the  ulna,  the  inside  of 

the  thumb  and  the  annular  ligament  in  the  front  of 

the  wrist,  are  respectively  the  most  painful  spots 

when  those  joints  are  severely  sprained. 

In  addition  to  joints  being  affected  by  adhesions, 
muscles  and  tendons  are  often  similarly  incapaci- 
tated, most  commonly  in  such  regions  as  the 
adductor  muscle  of  the  thigh,  which  are  often  found 
contracted  and  stiff  in  cases  of  chronic  rider's 
sprain  ;  the  muscles  of  the  forearm,  especially  the 
supinator  longus,  and  extensors  of  the  wrist  from  a 
condition  of  chronic  tennis  elbow ;  the  muscles  of 
the  calf  and  tendo-achillis  from  neglected  tennis 
calf.  Careful  examination  in  such  cases  will  reveal 
a  painful,  though  comparatively  slight,  interference 
with  the  normal  range  of  movement,  to  cure  which 
forcible  manipulation  will  be  often  just  as  necessary 


16  PRINCIPLES  OF  BONESETTING 

as  in  joints  whose  action  is  entirely  crippled  by 
adhesions.  Some  authorities  state  that  previous  to 
attempting  these  operations  on  ankylosed  joints 
careful  preparation  for  a  week  beforehand  by  hot 
fomentations  and  massage  is  essential.  These 
preliminaries,  though  originally  employed  by  older 
bonesetters,  are  not  now  needful,  though  perhaps 
in  certain  cases  of  long  standing,  where  the  whole 
limb  is  stiff  from  disease,  a  few  radiant  heat  baths, 
combined  with  massage,  might  prove  useful  by 
rendering  the  muscles  more  supple.  Again,  it  has 
been  suggested  that  in  such  circumstances  tenotomy 
should  be  previously  performed,  but  in  the  majority 
of  cases  nowadays  proper  attention  to  the  after 
treatment  makes  this  a  quite  unnecessary  procedure. 

Unless  contra-indicated,  when  adhesions  are  to 
be  broken  down  an  anaesthetic  must  always  be 
given,  not  so  much  for  the  avoidance  of  pain  as  to 
ensure  complete  relaxation  of  the  muscles.  By 
dispensing  with  an  anaesthetic  the  difficulties  of 
the  operation  are  increased,  as  it  will  be  necessary 
to  overcome  muscles  which  the  patient  will  invol- 
untarily put  into  action  for  the  protection  of  the 
joint  before  the  adhesions  can  be  satisfactorily 
ruptured.  At  the  same  time  a  risk  is  run  of 
severely  straining  or  rupturing  the  contracted 
muscles. 

Since  it  does  not  produce  sufficient  muscular 
relaxation     nitrous     oxide     gas     should     not     be 


PRINCIPLES  OF  BONESBTTING  17 

selected  as  the  anaesthetic,  and  it  is  possible  that 
where  severe  inflammation  has  followed  forcible 
movements  in  suitable  cases  these  points  have  not 
been  observed.  Where  manipulation  has  been 
properly  performed  no  untoward  result  need  be 
feared,  as  there  is  nothing  in  the  rupture  of  fibrous 
bands  to  cause  inflammatory  action,  provided  the 
case  is  otherwise  suitable. 

In  the  description  given  by  Dr.  Wharton  Hood 
of  Hutton's  methods  no  mention  is  made  of 
anaesthetics;  he  says,  "the  resistance  of  the 
muscles  is  overcome,  or,  at  least,  reduced  to  a 
minimum,  by  rotating  the  limb  as  much  as  possible 
on  its  axis.  In  this  way  the  muscles  are  thrown 
out  of  their  ordinary  lines  of  action  and  are  rendered 
almost  powerless."  By  this  rotation,  muscular 
resistance  was  evaded,  and,  as  Hutton  was  wont  to 
say,  "  Pulling  is  of  little  use ;  the  twist  is  the  thing." 

The  principles  by  which  the  operator  should  be 
guided  when  undertaking  the  breaking  down  of 
adhesions,  are,  to  obtain  sufficient  firmness  of  grasp, 
sufficient  leverage  to  apply  the  necessary  force,  and 
to  apply  it  in  the  first  instance  in  the  opposite 
direction  to  which  movement  is  defective  ;  that  is 
to  say,  the  extension  being  painful  and  defective 
the  first  movements  should  be  in  the  direction  of 
flexion.  Generally  speaking,  the  movements  should 
be  performed  in  a  swift,  even  and  firm  manner,  so 
that   a  joint  undergoes  the  motions  of  its  normal 


18  PRINCIPLES  OF  BONESETTING 

action,  though  not  necessarily  to  the  full  extent  of 
its  range.  The  reason  of  this  is  that  the  muscles 
will  have  contracted  in  proportion  to  the  limitation 
of  movement  permitted  by  the  adhesions,  and  once 
that  limitation  has  been  overcome  the  contraction 
of  the  muscles  will  be  the  only  impediment  to  the 
normal  range.  The  adhesions  once  ruptured  after 
treatment  will  speedily  restore  the  elasticity  of  the 
muscles,  which  might  well  be  strained  should  the 
full  extent  of  movement  be  at  once  sought. 

In  cases  of  long  standing  the  adhesions  yield 
with  a  distinct,  audible  snap  or  crackle  ;  others  of 
less  duration  with  the  noise  of  tearing  parchment, 
whilst  those  of  still  more  recent  date,  though  giving 
no  audible  sound,  can  generally  be  felt  by  the 
fingers  of  the  operator.  Experience  shows  that 
rapidity  in  the  execution  of  the  movements  gives 
rise  to  far  less  after-pain  than  if  the  adhesions  are 
broken  down  by  slow  and  deliberate  stretching,  but 
care  must  be  exercised  against  jerks  or  undue 
violence.  When  taking  hold  of  a  limb  the  grasp 
should  be  just  above  and  just  below  the  affected 
joint,  for  though  a  more  powerful  leverage  could 
be  obtained  by  more  distant  grips,  yet  it  is  as  well 
to  bear  in  mind  that  other  structures  may  be  broken 
besides  adhesions,  whilst  in  the  young  there  is 
danger  of  separating  the  epiphysis.  Formerly,  in 
the  pre-ansesthetic  days,  the  use  of  the  long  lever- 
age was   employed,   but  now  muscles  can  be  so 


PRINCIPLES  OF  BONESETTING  19 

easily  relaxed  by  anaesthesia  it  is  safer  to  act  as 
described. 

After-pain  is  certain  to  be  present  in  varying 
degrees,  but  will  pass  off  in  the  course  of  an  hour 
or  so,  and  provided  sufficient  care  has  been  taken 
in  the  operation  no  apprehension  need  be  felt  on 
this  point.  Within  a  few  hours  the  joint  should  be 
gently  massaged  and  movements  aided.  On  com- 
mencement the  massage  must  be  of  the  lightest 
description  and  should  consist  of  gentle,  stroking 
movements  in  the  direction  of  the  trunk.  As  the 
pain  subsides,  the  rubbing  may  be  of  a  more 
vigorous  character  and  voluntary  movements  of  the 
limb  aided  and  encouraged,  but  all  semblance  of 
roughness  must  be  avoided.  The  rubbing  should 
last  about  twenty  minutes  to  half  an  hour.  The 
mere  allowing  a  joint  to  remain  quiescent  for  forty- 
eight  hours,  as  is  sometimes  recommended,  is  not 
safe  ;  sufficient  time  may  then  be  given  to  allow 
the  freshly  ruptured  adhesions  to  re-unite.  Not- 
withstanding the  pain,  every  effort  should  be  made 
to  keep  the  joint  free,  and  on  no  account  should 
any  bandage  or  splint  be  applied.  It  will  be  found 
that  the  rubbing,  if  skilfully  performed,  gives  great 
relief  from  the  pain,  and  local  application  is  scarcely 
ever  required. 

In  patients  who  show  great  intolerance  to  the 
least  discomfort  or  pain,  dry  heat  by  means  of  hot 
salt  bags  and  the  administration  of  a  few  grains  of 


20  PRINCIPLES  OF  BONESETTING 

aspirin  usually  afford  relief.  Occasionally  full 
movement  and  freedom  from  pain  follow  the 
manipulations,  but  this  ideal  result  is  rare  ;  more 
often  a  patient  is  quite  unable  to  move  the  joint 
beyond  the  extent  obtained  under  the  anaesthetic, 
though  a  sense  of  greater  freedom  is  usually  ex- 
perienced, the  explanation  being  that  though  there 
is  no  longer  mechanical  obstruction  in  the  joint,  the 
muscles,  from  disuse,  are  so  wasted  and  contracted 
that  they  are  physically  incapable  of  normal  work. 
To  dismiss  a  patient  without  correcting  this  con- 
dition is  to  court  almost  certain  failure.  Simply  to 
order  the  joint  to  be  used  is  for  the  most  part 
useless,  as  few  people  have  the  strength  of  will 
necessary  to  make  muscles  perform  their  proper 
functions  at  the  expense  of  pain. 

It  is  the  custom  of  a  large  number  of  bonesetters 
to  administer  an  anaesthetic,  on  two  or  three 
subsequent  occasions,  for  the  purpose  of  overcom- 
ing the  muscular  resistance.  This  should  never 
really  be  necessary  if  the  adhesions  have  been 
properly  dealt  with  at  the  time  of  the  operation, 
and  the  most  satisfactory  treatment  after  the  first 
two  days  consists  in  substituting  for  the  rubbing 
graduated  exercises,  by  means  of  weights  and 
pulleys.  These  exercises,  though  possibly  painful, 
must  be  performed  daily,  when  it  will  be  found  that 
an  increase  of  strength  and  mobility  bring  decrease 
of  pain.     Exercises  should  be  diligently  persevered 


PRINCIPLES  OF  BONESETTING  21 

in  till  the  muscles  have  regained  their  former  bulk 
and  the  joint  its  full  power  of  movement.  Such 
are  the  broad  principles  upon  which  bonesetting  is 
based,  and  though  in  certain  particulars  the  pro- 
cedure which  is  set  out  differs  from  that  advised  by 
some  surgeons,  it  embodies  the  experience  gained 
in  a  large  number  of  cases  in  which  success  has 
followed  its  adoption. 

Before  describing  the  various  movements  which 
will  be  required  for  each  joint  it  may  be  as  well  to 
emphasize  some  of  the  more  important  points  to  be 
observed  in  their  performance. 

In  the  first  place,  an  anaesthetic  should  always 
be  employed,  even  for  the  apparently  trivial  cases, 
as  apart  from  the  chance  of  meeting  with  undue 
muscular  resistance  the  pain  experienced  by  the 
patient  is  sometimes  out  of  all  proportion  to  the 
amout  of  disability  present. 

Secondly,  the  movements  should  be  executed  in 
a  quick,  smooth  manner,  avoiding  all  jerks  and 
undue  violence. 

Thirdly,  in  seizing  the  limb  a  short  leverage 
should  be  taken  for  fear  of  fracture.  Once  the 
adhesions  have  ruptured  full  movement  of  the  joint 
must  not  be  sought  for  fear  of  over-straining  the 
contracted  muscles.  In  all  cases  in  which  diagnosis 
is  doubtful  it  is  advisable  to  obtain  a  radiograph, 
in  order  that  any  morbid  condition  may  be  excluded. 


CHAPTER   III 

MANIPULATIONS 

When  a  patient  seeks  advice  concerning  a  joint 
which  continues  to  be  painful  on  use  in  spite  of 
the  usual  remedies,  many  weeks  after  the  receipt 
of  an  injury,  the  possible  presence  of  some  adhe- 
sions should  be  considered.  Enquiry  should  be 
made  as  to  whether  the  original  hurt  affected  the 
joint  sufficiently  to  cause  acute  synovitis,  or  if  the 
structures  in  its  immediate  neighbourhood  were 
alone  implicated.  In  the  former,  any  impeding 
bands  of  adhesions  are  probably  connected  with 
the  synovial  membrane,  in  addition  to  which,  in 
middle-aged  people,  it  is  possible  some  arthritic 
changes  of  the  bones  may  be  developing.  In  such 
cases  a  radiograph  is  desirable,  which  would 
demonstrate  these  changes,  if  existing,  and  though 
the  presence  of  such  a  condition  does  not  preclude 
improvement  by  manipulation,  yet  it  is  as  well  to 
give  a  guarded  prognosis  as  to  complete  recovery. 
Should  the  stiffness  and  pain  exist  where  there  has 
been  no  inflammation  of  the  joint,  but  which 
remains  impaired  through  the  rest  necessitated  for 
either  fracture  of  the  bones  or  injury  to  the  adjacent 


MANIPULATIONS  23 

soft  parts,  the  adhesions  are  nearly  always  peri- 
articular, or  connected  with  the  tendons,  and  here 
forcible  movements  give  excellent  results.  In  the 
majority  of  these  cases  the  pain  complained  of  is 
only  experienced  on  attempting  to  use  the  joint 
normally,  and  it  is  sometimes  difficult  to  get 
patients  to  understand  that  an  active  condition  of 
injury,  necessitating  continued  care,  no  longer 
exists,  or  realize  that  the  case  has  gradually  merged 
into  one  where  a  more  strenuous  line  of  treatment 
is  essential  to  complete  recovery.  Some  people 
are  so  intolerant  of  pain  in  any  form  that  they 
exaggerate  discomfort  into  pain,  and  pain  into 
agony,  and  this  type  of  patient  is  apt  to  resent  any 
treatment  which  entails  endurance  or  discomfort. 
On  the  other  hand,  I  once  saw  a  man  who  for  five 
days  had  been  going  about  with  a  complete  frac- 
ture of  the  shaft  of  the  ulna,  who  only  took  advice 
because  of  the  "funny  feeling"  experienced,  so 
that,  diagnostically  speaking,  the  degree  of  pain 
felt  is  but  a  small  criterion  of  gravity. 

Where,  however,  pain  is  constant  and  independ- 
ent of  movement,  it  is  unwise  to  interfere  without 
the  greatest  care  being  previously  taken  to  eliminate 
anything  of  a  serious  nature.  Questions  should  be 
asked  with  a  view  to  determining,  if  possible,  the 
exact  situation  of  the  pain,  and  in  a  large  number 
of  cases  this  will  be  found  to  correspond  with  those 
described  by  Hood  and  Dacre  Fox  ;  these  spots, 


24  MANIPULATIONS 

moreover,  are  occasionally  tender  on  pressure. 
The  corresponding  joint  on  the  sound  side  should 
be  examined  at  the  same  time,  careful  comparison 
made  of  the  difference  in  the  range  of  movement, 
and  to  what  extent  movement  can  be  performed 
before  pain  is  elicited.  The  condition  and  tone  of 
the  muscles  should  be  also  observed,  since  a  differ- 
ence between  the  opposite  sides  will  usually 
necessitate  more  lengthy  attention  to  the  after 
treatment.  Generally  speaking,  where  the  muscles 
on  the  affected  sides  are  stiff  and  rigid  in  addition 
to  being  wasted,  it  is  advisable  that  the  rubbing, 
which  ordinarily  will  be  found  only  necessary  for 
a  period  of  four  or  five  days,  be  continued  in  con- 
junction with  exercises  for  another  ten  days  or 
longer. 

The  Shoulder  Joint 

The  shoulder,  from  its  great  liability  to  injuries, 
is  perhaps  the  joint  most  commonly  incapacitated 
by  adhesions.  It  is  for  this  reason  that  the  mani- 
pulations necessary  for  its  restoration  are  first 
described. 

This  joint,  being  capable  of  a  very  wide  and 
varied  range  of  movement,  a  slight  impairment  of 
one  of  them  is  liable  to  follow  any  injury  to  that 
region.  Apart  from  the  disability  following  the 
more  serious  accidents,  such  as  dislocations  or 
fractures,  adhesions  follow  a  variety  of  quite  trivial 
mishaps,  which  at  the  time  have  not  been  considered 


MANIPULATIONS  25 

sufficiently  serious  to  need  the  services  of  a 
medical  man.  Amongst  them  that  of  "  throwing 
the  arm  out "  is  a  very  common  cause  in  men  past 
middle  age.  Having  thrown  some  light  object, 
such  as  a  stone  or  a  tennis  ball,  they  have  at  once 
experienced  a  sickening  pain  in  the  shoulder,  and, 
though  the  acuteness  passes  off  within  a  few  min- 
utes, it  sometimes  happens  that  they  never  quite 
recover  full  power  in  the  arm,  or  lose  a  tendency 
to  a  sharp  pain  on  certain  movements.  This  delay 
in  recovery  is  due  to  some  adventitious  band, 
usually  connected  with  the  biceps  tendon,  and 
recovery  will  not  be  complete  until  this  impediment 
has  been  remedied. 

Another  quite  common  accident,  setting  up  a 
similar  condition,  is  caused  by  jumping  off  a  moving 
vehicle,  such  as  an  omnibus,  with  the  hand  still 
holding  the  rail ;  habitually  over-swinging  at  golf 
with  a  club  too  heavy  for  proper  control,  over-hand 
serving  with  a  heavy  racquet  at  tennis,  however, 
and  the  irritation  caused  to  a  joint  by  the  vibration 
of  the  handles  of  a  bicycle,  which  were  grasped  too 
tightly  by  a  beginner,  are  amongst  the  rarer  causes 
met. 

Although  complete  ankylosis  is  rare,  adhesions 
in  and  around  this  joint  often  exist,  causing  con- 
siderable loss  of  movement,  which  to  a  certain 
extent  may  be  masked  by  the  apparent  freedom 
allowed  by  the  scapula.    Therefore,  when  examining 


26  MANIPULATIONS 

a  shoulder  in  which  adhesions  are  suspected, 
the  scapula  should  always  be  fixed  by  the  hand 
whilst  the  movements  are  tested.  When  the 
mobility  of  the  shoulder  joint  is  impaired  by 
adhesions  the  arm  is  carried  in  a  stiff,  unnatural 
manner,  and  though  antero-posterior  movements 
may  be  fairly  free,  any  attempt  to  raise  the  arm 
above  the  level  of  the  joint  causes  the  whole 
shoulder  to  go  up  until  the  rotation  of  the  scapula 
has  reached  its  limit. 

Placing  the  hand  behind  the  back,  in  such  an 
action  as  buttoning  the  braces,  or  that  curious 
shrug  of  the  shoulder  entailed  in  the  putting  on  or 
taking  off  a  coat,  are  other  motions  usually  found 
defective.  Provided  no  movement  of  the  joint  is 
made  which  pulls  on  the  adhesions,  pain  is  not  as  a 
rule  a  marked  symptom.  At  night,  however,  this 
is  the  reverse,  and  the  patient  usually  complains  of 
being  wakened  at  intervals  by  a  considerable 
amount  of  pain,  which  is  frequently  attributed  to 
rheumatism.  The  explanation  is  that  during  the 
day  time  any  movement  likely  to  cause  pain  is 
prevented  by  the  contraction  of  the  controlling 
muscles,  but  as  soon  as  sleep  supervenes  these 
muscles  gradually  relax  till  the  steady  drag  of  the 
limb  on  the  adhesions  sets  up  a  sufficient  amount 
of  pain  to  arouse  consciousness.  In  all  cases  in 
which  there  is  much  disability  adhesions  will  be 
mainly  found  in  the  posterior  and  inferior  folds  of 


MANIPULATIONS  27 

the  capsular  ligament  and  will  account  for  the  loss 
of  the  movements  mentioned. 

In  those  vague  conditions  in  which  complaint  is 
made  of  occasional  very  acute  pain  in  the  front  of 
the  shoulder,  caused  through  some  particular 
motion,  but  in  which  no  marked  loss  of  mobility  is 
found,  small  adhesions  frequently  exist  in  the 
tendon  sheath  of  the  long  head  of  the  biceps  where 
it  dips  into  the  joint. 

Again,  where  abduction  is  found  to  tbe  slightly 
defective  a  pain  is  experienced  on  the  outer  side  of 
the  joint,  the  bursa  of  the  deltoid  has  sometimes 
become  adherent,  through  inflammation,  to  the  sur- 
rounding tissues.  In  such  circumstances  as  these 
manipulation  will  afford  a  speedy  and  effective  cure. 

The  patient  should  lie  on  a  bed  or  couch  with 
the  affected  limb  freed  of  clothing.  Anaesthesia 
having  been  established,  the  method  of  procedure 
in  the  case  of  a  right  shoulder  is  as  follows  : — 

The  operator  grasps  the  elbow  joint  with  his 
right  hand,  whilst  his  left  steadies  the  shoulder. 
He  then  quickly  rotates  the  head  of  the  humerus 
till  it  is  felt  by  the  left  hand  to  be  moving  freely. 
Sliding  his  right  hand  up,  he  seizes  the  arm  close 
up  to  the  joint  and  carries  the  limb  across  the  chest 
till  the  limb  reaches  the  middle  line,  where  he 
again  quickly  rotates  and  then  brings  it  back  to  its 
former  position.  With  the  left  hand  still  steadying 
the  shoulder,  the  arm  is  made  to  move  in  gradually 


28  MANIPULATIONS 

increasing  circles,  till  any  adhesions  are  felt  to 
yield.  The  patient  is  then  half  turned  over,  and 
the  arm  and  hand  made  to  go  behind  the  back,  the 
thumb  of  the  operator  being  firmly  pressed  over 
the  bicipital  groove  in  order  to  prevent  any  possible 
movement  of  the  sheath  interfering  with  the 
rupture  of  the  adhesions  which  impede  free  play  of 
the  tendon.  The  arm  must  now  be  abducted 
firmly  with  the  external  condyles  uppermost,  whilst 
the  operator's  left  hand  pushes  against  and  resists 
rotation  of  the  scapula  until  the  adhesions  yield 
with  their  characteristic  tear ;  the  arm  should  then 
be  quickly  rotated  outwards  and  carried  upwards 
and  to  the  front.  These  movements,  if  properly 
carried  out,  are  sufficient  to  rupture  any  adhesions 
that  may  exist  in  or  around  the  joint,  and,  provided 
no  undue  violence  has  been  used,  no  inflammation 
will  ensue.  Pain,  however,  will  be  present  to  a 
certain  extent,  but  even  when  severe  no  appre- 
hensions need  be  felt.  Within  an  hour  or  so  of 
the  operation  the  shoulder  should  be  gently  rubbed 
and  moved ;  this,  if  carefully  performed,  will 
greatly  relieve  the  pain,  and  rarely  will  any  local 
application  be  necessary.  Rubbing  and  movements 
must  be  continued  daily,  and  on  no  account  should 
the  arm  be  slung  or  kept  immobile.  Within  a  few 
days  exercises,  preferably  by  means  of  weights  and 
pulleys,  should  be  commenced,  to  restore  the 
inevitably  wasted  and  contracted  muscles. 


MANIPULATIONS  29 

The   Elbow  Joint 

Even  comparatively  trivial  injuries  of  the  elbow- 
are    liable    to  be  followed  by  impairment  of  the 
normal  ability.     In  a  large  number  of  cases,  where 
a  too  prolonged  use  of  the  sling  has  been  permitted, 
though  a  certain  amount  of  flexion  and  extension 
is  painlessly  and   easily  performed,   anything  like 
free  use  of  the  joint  is  prevented  by  the  obstruction 
of  the  biceps  and   triceps   muscles.     Indeed,   the 
limitation  of  the  movement  allowed  by  this  con- 
traction is  often  so  restricted  that  till  it  is  overcome 
the  additional  presence  of  adhesions  is  not  always 
easy  of  diagnosis.     Even  when  adhesions  are  the 
principal  cause  of  the  stiffness,  pain  on  use  is  not  a 
marked    symptom,    unless   the   joint   be    suddenly 
moved  beyond  the  limits  of  its  existing  range.     In 
cases  where  recovery  is  slow,  by  the  more  ordinary 
means    of    treatment,    soundness    is    undoubtedly 
hastened  by  manipulating  the  joint  and  carefully 
stretching  the    contracted   muscles.     Occasionally 
the    full    range    of    movement    can    be    obtained 
immediately  anaesthesia  is   established ;  but   more 
often,    apart   from   the    presence    of  adhesions,    a 
considerable    amount    of    muscular    resistance    is 
experienced,    especially    if    the    case   be   of  long 
standing. 

The  hands  should  grasp  the  limb  just  above  and 
below  the  joint  when  effecting  the  necessary  move- 
ments, care  being  taken  to  keep  the  thumb  of  the 


30  MANIPULATIONS 

lower  hand  firmly  pressed  over  the  head  of  the 
radius  during  the  extension  of  the  joint,  lest  the 
pull  of  the  contracted  biceps  cause  dislocation  of 
that  bone.  Rotatory  movements  of  the  forearm 
must  first  of  all  be  made,  followed  by  a  rocking 
of  the  joints  backwards  and  forwards,  the  first 
motion  of  which  should  be  in  the  direction  of  the 
least  resistance  ;  that  is  to  say,  if  flexion  is  the  more 
defective  movement  the  elbow  should  be  extended, 
and  then  flexed  carefully,  increasing  the  range  on 
the  principle  of  a  swinging  pendulum.  When 
mobility  of  the  joint  is  fairly  free,  the  muscles 
should  be  carefully  stretched.  This  can  be  best 
accomplished  by  a  series  of  intermittent  jerks,  and 
the  muscles  appear  to  yield  more  readily  than  if 
they  are  stretched  by  continuous  pressure  or  strain. 
Should  there  have  been  any  interference  with  the 
proper  performance  of  pronation  or  supination,  the 
forearm  must  be  briskly  put  through  its  move- 
ments. In  certain  cases  of  chronic  tennis  elbow, 
where  the  muscles  at  fault  are  found  to  be  rigid, 
manipulation  is  often  of  the  greatest  value.  Before 
going  through  the  movements  already  detailed,  the 
affected  muscles  should  receive  special  attention. 

The  best  way  of  restoring  the  suppleness  is  to 
grasp  a  few  inches  of  the  muscle  between  the 
fingers  and  thumbs  of  both  hands,  and  moving  the 
muscle  laterally  between  the  fingers  knead  it 
gradually  through  its  whole  length.     After  acting  in 


MANIPULATIONS  31 

this  way  flex  the  wrist  to  put  the  extensors  on  the 
stretch  and  then  straighten  the  elbow  joint. 

As  in  former  cases,  rubbing  and  exercises  will 
complete  the  cure. 

The   Knee  Joint 

The  medical  profession  fully  appreciates  the 
value  of  early  movement  and  massage  in  the  treat- 
ment of  acute  traumatic  synovitis,  but  in  spite  of 
the  adoption  of  modern  methods,  small  adhesions 
are  formed  in  this  joint  more  generally  than  is 
usually  suspected,  and  it  is  especially  with  regard 
to  these  indefinitely  crippled  limbs  that  the  modern 
bonesetter  gains  such  success. 

The  treatment  and  cure  of  the  acute  condition 
should  not  be  the  only  aim  of  the  practitioner. 
The  invariably  wasted  muscles  and  occasionally 
painful  joint  rendered  by  the  more  immediate 
effects  of  injury  should  not  be  left  for  time  to  cure, 
but  efforts  should  be  made  by  means  of  suitable 
exercises  and  electrical  treatment  to  bring  about 
perfect  soundness  before  dismissing  the  patient. 
Where  there  is  no  evidence  of  disease  or  any 
internal  derangement  of  the  knee  joint,  but  where, 
in  spite  of  treatment,  certain  movements  continue 
to  be  painful  or  defective,  the  possibility  of  adhe- 
sions should  be  considered.  In  the  more  severe 
cases,  where  any  useful  movement  of  the  joint  has 
been  lost,  adhesions  are  easily  recognizable,  but  in 


32  MANIPULATIONS 

certain  conditions  where  there  may  be  merely  a 
painful  interference  with  the  play  of  full  extension 
or  full  flexion,  their  presence  is  liable  to  be  over- 
looked. 

It  will  be  found  that  these  lesions  usually  occur 
when  the  synovitis  has  been  due  to  a  strain  of  the 
joint,  in  contra-distinction  to  that  resulting  from 
direct  injury,  and  it  may  be  assumed,  therefore,  that 
the  adhesions  are  connected  with  the  tendons  con- 
trolling the  joint.  Again,  the  pain  is  more  usually 
noticed  on  the  inner  side  of  the  joint;  the  struc- 
tures in  that  region  being  more  liable  to  injury  from 
the  tendency  of  a  straining  joint  to  yield  on  the 
inner  aspect,  adhesions  are  likely  to  form  there. 

The  manipulations  necessary  for  the  correction 
of  such  disability  are  as  follows  : — 

The  patient  being  duly  anaesthetized  should  be 
so  placed  that  the  affected  limb  extends  over  the 
edge  of  the  bed,  as  far  as  the  popliteal  space.  The 
operator  should  then  grasp  the  patient's  foot 
between  his  thighs  and  with  his  hands  rock  the 
patella  from  side  to  side,  to  free  it  from  any  possible 
adhesions,  and  no  attempt  at  flexion  of  the  joint 
should  be  made  till  this  be  found  to  be  moving 
freely.  Cases  have  occurred  in  which  fracture  of 
the  patella  has  resulted  owing  to  the  neglect  of  this 
important  point.  The  operator  now  bends  his 
knees,  whilst  his  hands  acting  as  a  fulcrum  firmly 
grasp  the  shaft  of  the  tibia  close  up  to  the  joint. 


MANIPULATIONS  33 

By  this  means  the  force  necessary  to  bend  the  knee 
and  rupture  the  adhesions  can  be  regulated  and 
the  muscular  resistance  appreciated.  No  attempt 
should  be  made  to  obtain  full  flexion  immediately, 
but  by  alternately  bending  and  straightening  the 
knees  free  movement  of  the  joint  will  gradually 
follow.  The  amount  of  resistance  offered  by  the 
contracted  extensor  femoris  should  be  the  guide  as 
to  how  far  it  will  be  permissible  to  continue  flexion, 
and  care  must  be  exercised  to  avoid  rupturing  or 
spraining  this  muscle.  Once  the  adhesions  have 
been  ruptured,  after  treatment  will  restore  the 
remaining  degrees  of  flexion.  The  operator  should 
next  make  a  quick  but  not  violent  rotatory  move- 
ment of  the  tibia,  whilst  his  thumbs  are  firmly 
pressed  against  the  sides  of  the  joint.  In  those 
cases  in  which  adhesions  are  preventing  the  full 
extension  of  the  joint,  but  where  flexion  is  normal, 
a  similar  grasp  should  be  employed,  the  only 
difference  being  that  the  force  will  be  applied  by 
straightening  the  knees  and  pushing  the  hands 
against  the  joint. 

Besides  manipulating  in  this  manner  for  the 
rupture  of  some  small  impeding  adhesions,  the 
unqualified  practitioner  is  particularly  successful  in 
certain  cases  of  internal  derangement  of  the  knee 
joint. 

The  medical  man  is  well  acquainted  with  the  signs 
of  the  well  marked  lesion  of  displaced  semi-lunar 


34  MANIPULATIONS 

cartilage,  and  is  quite  capable  of  effecting  its 
reduction,  but  there  is  another  frequent  cause  of 
disability  in  the  knee  joint  which  is  not  so  generally 
recognized.  The  history  in  this  class  of  case  tells 
of  some  sprain  of  the  joint,  followed  perhaps  by  a 
mild  attack  of  synovitis,  during  which  no  apparent 
signs  of  displaced  cartilage  are  to  be  detected. 
Gradually  the  swelling  in  the  joint  subsides  and 
the  patient  is  able  to  get  about,  but  it  is  found 
that  full  extension  of  the  limb  is  not  quite  perfect, 
and  though  pain  is  not  a  marked  symptom,  yet  any 
attempt  to  brace  the  knee  back  in  complete  ex- 
tension is  rendered  futile,  not  only  by  the  discomfort 
produced  in  the  front  of  the  joint  but  by  a  sense  of 
something  checking  the  full  action  at  the  same 
situation.  This  slight  but  common  form  of 
locking  has  been  attributed  to  a  fringe  or  hyper- 
trophied  portion  of  the  synovial  membrane  becom- 
ing nipped,  either  at  the  time  of  the  injury  or  as  a 
result  of  the  semi-flexed  position  assumed  by  a  knee 
joint  in  acute  synovitis,  allowing  the  hypertrophied 
fringe  to  protrude  ;  this  fringe,  as  the  swelling 
subsides  in  the  gradually  straightening  joint,  may 
get  caught  between  the  condyles.  The  treatment 
is  practically  the  same  as  that  employed  for  the 
reduction  of  a  displaced  semi-lunar  cartilage,  flexing 
the  knee  fully  and  exerting  firm  pressure  with  the 
thumbs  on  the  painful  spot,  and  then,  with  a  slight 
lateral  movement,  sharply  straightening  the  leg. 


MANIPULATIONS  35 

Wrist  Joint 

Regarding  the  various  accidents  that  may  render 
this  joint  partially  useless,  ordinary  sprains  of  the 
wrist  are  often  delayed  in  recovery  by  the  presence 
of  some  small  adhesions  or  some  inspissated  synovial 
fluid  in  a  tendon,  causing  pain  on  certain  move- 
ments, even  if  no  appreciable  loss  of  movement  is 
apparent.  Again,  the  amount  of  rest  on  a  splint 
necessary  for  the  healing  of  a  fracture  in  the 
neighbourhood,  such  as  a  Colles'  fracture,  may  be 
sufficient  to  allow  the  carpal  bones  to  be  similarly 
incapacitated,  and  the  movements  of  flexion  and 
extension  will  be  found  defective,  even  when 
massage  has  been  employed  from  the  earliest  date. 

The  actions  of  supination  and  pronation  of  the 
hand  are  likewise  often  faulty.  In  these  circum- 
stances it  is  advisable,  if  further  massage  does  not 
give  relief  within  a  few  days,  to  expedite  recovery 
by  manipulation.  To  loosen  the  wrist,  the  lower 
end  of  the  forearm  should  be  grasped  in  one  hand 
and  the  carpus  and  metacarpus  grasped  in  the  other. 
Provided  extension  is  the  more  defective  move- 
ment, manipulation  should  be  briskly  done  in  the 
direction  of  flexion  to  commence  with,  then 
extension  till  the  joint  works  freely.  Grasping  the 
hand  in  the  same  action  as  the  ordinary  hand-shake, 
with  the  forearm  still  held  by  the  other,  short,  rapid 
movements  should  now  be  made  laterally,  followed 
by  rotatory  movements  and  the  actions  of  pronation 


36  MANIPULATIONS 

and  supination.  If,  from  similar  cause,  the  digital 
articulations  are  rigid,  the  affected  finger  should  be 
grasped  between  the  fingers  of  one  hand,  while  the 
thumb  and  two  first  fingers  of  the  other  flex  and 
extend  the  joint. 

Where  the  whole  hand  is  stiff  from  the  too 
prolonged  use  of  a  splint,  the  articulations  of 
metacarpal  bones  are  commonly  impeded  by  adhe- 
sions ;  they  should  be  grasped  at  the  digital 
articulation  between  the  finger  and  thumb  of  one 
hand,  the  other  hand  seizing  the  second  metacarpal 
in  like  manner.  The  bones  are  then  briskly  flexed 
and  extended  in  opposition  to  each  other ;  that  is 
to  say,  whilst  the  first  bone  is  extended  the  second 
is  flexed,  and  vice  versa.  The  remainder  must  be 
dealt  with  in  like  manner  until  the  mobility  is 
established.  The  whole  hand  should  then  be 
crumpled  up  in  the  action  of  clenching  the  fist  and 
firmly  squeezed. 

The  Ankle  Joint 

Any  severe  injury  in  the  neighbourhood  of  the 
ankle  joint  which  necessitates  prolonged  immo- 
bility is  frequently  followed  by  the  formation  of 
adhesions,  either  in  the  joint  itself  or  amongst  the 
tendons ;  though  a  certain  amount  of  movement  is 
usually  possible,  in  the  majority  of  cases  any 
attempt  to  use  it  in  a  normal  manner,  or  obtain 
a    greater    range    of    movement,    gives    rise    to 


MANIPULATIONS  37 

considerable  pain.  Walking  is  only  accomplished 
by  keeping  the  ankle  rigid  and  everting  the  foot 
instead  of  the  ordinary  toe  and  heel  method  of 
progression.  Flexion  is  the  movement  most  com- 
monly found  to  be  at  fault,  since  in  most  cases  of  a 
fracture  in  that  region  the  foot  is  kept  at  right 
angles  to  the  leg.  Again,  though  the  flexion  and 
extension  may  be  perfectly  normal,  the  movements 
of  eversion  and  inversion  are  often  found  defective 
and  painful  from  the  presence  of  adhesions  in  the 
tendons  passing  round  the  malleoli.  In  such  con- 
ditions recovery  can  be  obtained  by  manipulating 
the  joint  under  anaesthesia. 

The  foot  should  be  seized  by  the  operator's 
right  hand,  while  the  left  takes  a  firm  hold  just 
above  the  joint,  and  short,  quick,  rocking  move- 
ments made  in  the  direction  of  extension  and  flexion. 
As  mobility  increases  the  knee  should  be  flexed  to 
relax  the  tendo-achillis,  and  greater  force  applied 
as  each  movement  of  extension  is  made.  When 
extension  of  the  foot  has  become  fairly  free,  flexion 
should  be  made  by  the  same  method,  only  that  the 
increasing  force  is  applied  in  the  direction  of. 
flexion.  The  foot  should  now  be  briskly  inverted 
and  everted,  and  then  made  to  describe  circles  from 
within  outwards  and  without  inwards. 

Where  these  movements  are  advisable  it  may 
happen  that  the  whole  foot  is  rigid  from  disuse, 
and  it  will  be  as  well  to  follow  the  description  of 


38  MANIPULATIONS 

the  manipulations  already  given  for  loosening  the 
stiff  digital  and  metacarpal  joints.  Mr.  Willett  and 
Mr.  Tubby  have  described  the  good  results  that 
can  be  obtained  by  manipulating  certain  severe 
types  of  flat  foot. 

Similarly,  the  bonesettervery  often  gives  complete 
relief,  by  means  of  his  movements,  to  those  cases  of 
continued  lameness  of  the  foot  which  persist  long 
after  all  active  signs  of  some  apparently  trivial 
sprain  of  the  sole  of  the  foot  have  passed  away. 
In  these  conditions  the  pain  complained  of  is 
vague  and  persistent,  closely  resembling  that  of 
pes  valgus  in  regard  to  its  situation  and  character, 
but  though  the  gait  in  walking  would  suggest  that 
the  arch  of  the  foot  had  dropped,  examination  fails 
to  detect  it.  It  is  often  assumed  that  the  case, 
however,  is  one  of  incipient  flat  foot,  for  the  relief 
of  which  faute  de  mieux  treatment  is  usually 
prescribed.  The  patient,  however,  finds  little  or 
no  relief  from  the  various  pads  and  alterations  to 
the  boot,  in  fact  the  pain  is  not  infrequently 
accentuated.  Careful  enquiry  and  examination 
will  usually  trace  the  pain  to  one  of  the  tarso- 
metatarsal bones,  most  commonly  the  first,  which, 
on  examination,  will  be  found  with  its  mobility 
either  defective  or  lost,  presumably  through  the 
presence  of  adhesions.  In  such  cases  I  have  found 
manipulations  give  the  most  satisfactory  results, 
and    am    convinced   that   a    large    number   of  the 


MANIPULATIONS  39 

alleged  flat  foot  cases  cured  by  the  London  bone- 
setters  are  such  as  I  have  described. 

Another  form  of  foot  lameness,  in  which  mani- 
pulation often  affords  good  results,  is  when  pain  is 
experienced  in  one  of  the  metatarso  phalangeal 
joints.  The  condition  is  very  similar  to  the 
metatarsalgia  described  by  Morton,  but  in  the 
cases  where  this  treatment  proves  useful,  besides 
the  pain  felt  on  walking  there  is  usually  deficiency 
of  mobility  in  the  affected  joint,  as  compared  with 
the  sound  side,  whilst  the  onset  of  the  trouble  can 
generally  be  traced  to  some  such  accident  as 
treading  on  a  stone  when  bare-footed  or  walking 
over  cobblestones  in  thin-soled  boots. 

The  Hip  Joint 

Perfect  recovery  from  injury  to  the  hip  is  often 
unduly  delayed  by  the  formation  of  adhesions, 
either  in  the  capsule  of  the  joint  or  the  surrounding 
muscles.  In  such  an  accident  as  fracture  of  the 
neck  of  the  femur  the  band  of  adhesions  may  be  so 
joined  as  to  cause  almost  complete  loss  of  move- 
ment. Better  results  are  obtained  by  cautious 
manipulations  of  this  joint  when  crippled  by 
rheumatoid  arthritis  than  in  any  other  similarly 
affected,  provided  there  is  still  some  degree  of  all 
the  movements  existent.  It  is  possible  that  owing 
to  the  pain  set  up  by  the  arthritic  changes  the 
muscles  in  control  contract  in  order  to  protect  the 


40  MANIPULATIONS 

joint  from  undue  movement,  and  by  so  doing  foster 
the  formation  of  some  fibrous  adhesions  which  thus 
increase  the  existing  disability. 

The  movement  made  under  anaesthesia  presum- 
ably ruptures  these  adhesions  and  stretches  the 
muscles,  and  by  so  doing  affords  considerable 
relief.  Improvement  cannot,  however,  be  main- 
tained if  the  general  condition  responsible  for  the 
arthritic  conditions  be  left  unattended,  and  treat- 
ment in  this  direction  should  also  be  given.  In 
those  cases  where  the  active  state  of  infection  has 
already  stopped,  the  benefit  gained  by  this  treat- 
ment has  often  been  remarkable.  Again,  the 
amount  of  destruction  of  the  normal  outlines  of  the 
joint,  as  seen  radiographically,  with  the  possibility 
of  the  range  of  movement  being  blocked  by 
osteophytic  formation,  must  be  taken  into  con- 
sideration, and  makes  it  difficult  to  promise  that 
the  relief  will  either  be  retained  or  permanently 
improved  until  the  joint  has  been  examined  under 
an  anaesthetic.  Provided  care  is  taken  in  the 
course  of  the  operation  no  fear  of  doing  harm  need 
be  felt,  even  if  no  good  be  afterwards  experienced. 
It  is  as  well,  therefore,  when  proposing  this  treat- 
ment with  regard  to  joints  attacked  by  rheumatoid 
arthritis,  to  explain  that  it  is  not  in  the  nature  of  a 
cure  but  merely  with  the  object  of  affording  tem- 
porary relief  with  the  possibility  of  continued 
improvement. 


MANIPULATIONS  41 

Simple  sprains  of  the  joint,  or  that  very  common 
injury  to  the  adductor  muscles  called  rider's  sprain, 
are  not  infrequently  followed  by  considerable 
interference  with  the  mobility  of  the  limb,  and 
though  flexion  and  extension  may  be  quite  unim- 
paired, the  actions  of  abduction  and  rotation 
outwards  are  limited  and  painful. 

In  the  performance  of  the  necessary  mani- 
pulations for  the  more  severe  cases  of  ankylosis  the 
hands  should  grasp  the  thigh  close  up  to  the  joint, 
and  by  quick,  circular  movements  obtain  a  certain 
degree  of  mobility,  whilst  the  pelvis  is  fixed  by  an 
assistant.  When  the  head  of  the  bone  is  felt  to  be 
moving  freely,  the  operator,  in  order  to  get  better 
leverage,  should  slip  his  shoulder  under  the  patient's 
knee,  and,  by  alternately  raising  and  lowering  his 
body,  obtain  gradually  increase  of  flexion,  the 
hands  in  the  meanwhile  still  continuing  the  circular 
movements  of  the  limb.  As  soon  as  the  thigh  is 
flexed  on  the  trunk  the  movements  of  abduction, 
adduction  and  rotation  should  be  briskly  performed. 
The  thigh  should  then  be  extended,  abduction 
again  performed,  and,  where  necessary,  the  con- 
tracted adductor  muscles  firmly  kneaded.  Finally, 
cross  the  leg  over  its  fellow  in  the  position  of 
extreme  adduction,  and  smartly  rotate  outwards. 
Should  the  thigh  be  fixed  by  adhesions  in  the 
position  of  flexion,  the  patient  must  be  rolled  on  to 
the  sound  side  and  the  thigh  extended.     In  the  less 


42  MANIPULATIONS 

serious  cases  the  shoulder  leverage  will  not  be 
requisite,  as  the  movements  can  be  carried  out  by 
the  grasp  of  the  hands  alone.  Where,  however, 
ankylosis  is  almost  complete,  such  leverage  will  be 
found  very  useful,  but  care  must  be  taken  to 
previously  loosen  the  joint  by  rotatory  movements 
before  attempting  flexion,  for  fear  of  fracturing  the 
neck  of  the  femur.  After  treatment  must  be  on 
the  same  lines  as  in  other  joints,  with  the  object 
of  restoring  mobility  and  restoring  the  wasted 
muscles. 

The  Spine 
The  advisability  of  manipulating  in  cases  of  pain 
and  stiffness  of  the  spinal  column  requires  careful 
consideration,  and  before  undertaking  the  responsi- 
bility of  doing  so  every  precaution  should  be  taken, 
by  means  of  radiography  and  other  means,  to 
eliminate  the  possible  presence  of  tubercular 
trouble.  It  is  particularly  in  regard  to  their  reck- 
less interference  in  caries  of  the  spine  that  makes 
the  advice  of  the  bonesetter  so  dangerous  when 
sought  in  connection  with  stiff  or  painful  backs. 
Judging  from  the  description  of  patients,  it  is  the 
custom  of  some  bonesetters  to  manipulate  and 
percuss  the  spine  in  practically  every  case,  in 
addition  to  the  treatment  of  any  joint  for  which 
they  have  been  consulted.  This  is  apparently  in 
accordance  with  the  views  of  the  osteopath,  who, 
looking  upon  most  ailments  as  being  due  to  some 


MANIPULATIONS  43 

defect  or  displacement  of  one  of  the  vertebrae,  most 
commonly  the  seventh  cervical,  advocate  routine 
manipulation  of  the  spine.  Apart  from  the  method- 
ical and  daily  manipulation  of  the  spine  in  cases 
of  scoliosis  and  kyphosis,  as  recommended  by 
orthopcedic  surgeons,  the  only  conditions  likely  to 
be  improved  by  forcible  movement  are  where  pain 
and  stiffness  have  followed  either  an  injury  to  or  a 
rheumatic  inflammation  of  the  muscular  structures. 
Falls  on  the  head  and  shoulders,  as  in  the  hunting 
field,  not  infrequently  leave  behind  painful  rigidity 
in  the  muscles  of  the  neck,  which  occasionally  will 
obstinately  resist  the  ordinary  course  of  treatment, 
and  here  free  movements  under  anaesthesia  is  often 
of  the  greatest  assistance.  The  best  way  of 
accomplishing  these  movements  is  to  take  hold  of 
the  patient's  head  with  both  hands,  one  being 
placed  under  the  chin  and  the  other  over  the 
occipital  region.  Firmly  but  cautiously  put  the 
head  through  the  actions  of  flexion  and  extension. 
These  movements  should  now  be  followed  by  those 
of  rotation  and  lateral  rocking  of  the  head,  finally 
the  muscles  of  the  neck  must  be  briskly  kneaded. 
It  is  best  that  the  first  movements  be  in  the  direction 
of  least  resistance,  that  is  to  say,  if,  for  example, 
rotation  to  the  right  is  the  more  defective  and 
painful  motion,  the  first  movement  should  be 
rotation  to  the  left,  and  vice  versa.  The  after 
treatment  consists  in  massage  and  exercise  as  in 


44  MANIPULATIONS 

other  cases.  Pain  and  stiffness  in  the  lumbar  region, 
arising  from  injury,  occasionally  persist  long  after 
the  immediate  and  acute  condition  has  passed  off. 
The  history  in  these  cases  tells  of  some  definite 
though  frequently  slight  sprain  of  the  back,  neces- 
sitating perhaps  but  a  few  days'  treatment  for  ap- 
parent recovery.  Instead  of  perfect  recovery  the 
pain,  though  rarely  severe,  never  quite  disappears, 
and  as  time  goes  on  it  becomes  more  persistent. 
Good  results  can  be  obtained  by  treatment  based 
on  the  assumption  that  the  condition  is  due  to  some 
adhesions  in  the  muscular  or  tendinous  structure  of 
those  parts.  On  examination  the  lumbar  muscles 
will  be  found  wasted,  whilst  those  on  the  affected 
side  are  usually  rigid  and  contracted,  and  it  may 
be  assumed  that  it  is  here  that  some  matting  of 
muscles  or  adhesions  among  the  deeper  tendons 
exist.  In  this  condition  of  what  may  be  termed 
traumatic  lumbago,  treatment  aims  at  stretching  the 
contracted  muscles  and  rupturing  any  possible 
adhesions.  An  anaesthetic  having  been  given,  the 
method  employed  is  this,  the  leg  on  the  sound  side 
is  flexed  at  the  knee  and  the  thigh  flexed  on  the 
body  till  the  knee  touches  the  chest  wall.  It  is 
then  brought  back  to  the  extended  position.  The 
leg  on  the  affected  side  is  now  put  through  the 
same  movements  and  comparison  can  be  made  as  to 
the  difference  in  resistance.  Both  legs  are  now 
brought  up  together,  and  both  knees  should  be  kept 


MANIPULATIONS  45 

pressed  against  the  chest  for  about  a  minute.  The 
legs  having  been  brought  to  the  extended  position 
once  more,  the  patient  is  now  raised  to  a  sitting 
posture.  The  operator  places  one  hand  firmly  on 
the  affected  side,  whilst  with  the  other  he  thrusts 
the  patient  back  on  to  the  couch,  the  hand  in  the 
middle  of  the  back,  acting  as  a  fulcrum,  causes 
extension  of  the  part.  By  these  movements  full 
extension  and  flexion  of  the  lumbar  region  is 
obtained.  Pain  rarely  follows  these  manipulations, 
and  greater  freedom  of  movement  is  experienced 
almost  immediately  afterwards,  but  treatment  by 
rubbing  and  exercise  will  be  essential  before 
recovery  can  be  considered  complete. 

Another  condition  met  with  in  this  region  in 
which  manipulative  treatment  is  often  of  great 
value  is  that  of  coccydynia.  Kicks  or  falls  on  to 
the  buttocks  whilst  in  the  sitting  posture,  though 
apparently  of  no  great  severity  at  the  time  of 
occurrence,  are  occasionally  followed  by  consider- 
able pain,  which  resists  all  the  more  usual  remedies 
for  its  relief.  In  such  a  condition,  prolonged 
sitting,  or  the  act  of  defalcation,  are  sufficient  to 
cause  pain,  and  patients  suffering  in  this  way  rarely 
sit  on  both  buttocks  simultaneously,  but  will  shift 
their  weight  when  sitting  f^rom  one  buttock  to  the 
other  in  their  endeavours  to  avoid  pressure  in  their 
coccygeal  region.  Some  cases,  indeed,  have  come 
under  observation  in  which  removal  of  the  coccyx 


46  MANIPULATIONS 

has  been  recommended  as  a  last  resource,  and  have 
been  entirely  remedied  by  the  subjoined  method, 
but  it  must  be  admitted  that  in  other  cases  of  this 
condition,  in  which  the  history  of  trauma  has  been 
vague,  no  relief  has  been  obtained.  Treatment 
consists  in  freely  moving  the  coccyx,  and  since  in 
the  majority  of  these  cases  the  bones  entering  into 
its  formation  are  found  either  defective  on  move- 
ment, or  quite  rigid,  it  may  be  assumed  that  adhe- 
sions are  formed  between  or  around  their  articula- 
tions. In  addition,  the  coccyx  may  be  found 
deflected  to  one  side  or  the  other.  In  order  to 
carry  out  the  proposed  manipulations  the  patient, 
previously  anaesthetized,  should  be  turned  on  to 
the  left  side  with  knees  drawn  up.  The  operator 
then  inserts  his  right  forefinger  into  the  rectum  till 
the  top  of  the  coccyx  can  be  felt,  whilst  the  fingers 
of  the  left  hand  exert  light  pressure  over  the 
coccyx  from  without.  The  index  fingers  of  both 
hands  now  rock  the  tip  of  the  coccyx  backwards 
and  forwards,  and  gradually  move  up  till  the  sacro- 
coccygeal joint  is  reached.  Careful  massage 
following  this  procedure  is  of  the  utmost  import- 
ance, and,  having  been  started  within  a  few  hours 
of  the  operation,  must  be  persisted  in  daily  till  all 
pain  has  disappeared,  which,  in  cases  of  long 
standing,  may  take  three  weeks  or  even  longer  to 
accomplish. 


CHAPTER  IV 

EXERCISES    IN   AFTER   TREATMENT 

In  addition  to  the  employment  of  immediate 
massage,  references  have  been  made  to  the  import- 
ance of  suitable  exercises  in  the  after  care  of  all 
cases  treated  by  forcible  manipulation.  Of  course 
their  necessity,  or  the  length  of  time  for  which  they 
will  have  to  be  maintained,  will  depend  on  the 
amount  of  muscular  wasting  found,  but  in  all  these 
cases  a  certain  degree  will  always  be  present, 
partially  from  disuse  and  partially  from  the  reflex 
action  of  the  original  hurt.  Galvanism  and  farada- 
ism  are  methods  commonly  adopted  to  remedy 
ordinary  cases  of  wasted  muscles,  especially  when 
due  to  some  definite  nerve  lesion.  When,  how- 
ever, the  wasting  is  due  to  the  causes  mentioned  in 
the  conditions  under  consideration,  the  stimulus 
received  from  the  mind  for  the  voluntary  action  of 
the  muscles  is  preferable.  These  exercises  should 
be  performed  by  means  of  weights  and  pulleys, 
which  offer  graduated  resistance  to  the  muscles, 
as  is  the  case  with  a  Benson,  Foot  or  similar 
machine,  but  a  simple  substitute  for  these  can 
easily  be  arranged  where,  for  some  reason  or  other, 


43  EXERCISES  IN  AFTER  TREATMENT 

they  cannot  be  employed.  Dr.  Wharton  Hood,  in 
his  book,  "  Treatment  of  Injuries,"  gives  the  reason 
why  he  advocates  this  form  of  exercising  in  prefer- 
ence to  any  other,  and  in  explanation  says : — 

"  The  residual  incapacity,  so  to  speak,  which  may 
be  left  behind  by  various  injuries,  will  usually 
require  for  its  removal  the  careful  employment  of 
muscular  exercises,  specially  designed  for  the  pur- 
poses which  they  are  intended  to  fulfil ;  and  that 
these  exercises,  generally  speaking,  cannot  be 
replaced  by  others.  A  healthy  person  may 
unquestionably  promote  not  only  general  muscular 
development,  but  also  the  development  of  particu- 
lar sets  of  muscles,  by  almost  any  kind  of  activity, 
which  calls  either  the  whole  or  a  part  of  the  body 
into  exertion  ;  and  for  the  purpose  of  what  may  be 
called  general  athleticism  all  manner  of  apparatus 
and  all  manner  of  schemes  of  exercise  are  already 
before  the  public,  and  may  be  employed  to  the 
taste  or  fancy  of  the  employer,  if  not  with  identical, 
at  least  with  comparable  and  fairly  equal  results. 
Clubs,  dumb-bells,  india-rubber  bands,  all  have 
their  uses,  and  their  advocates ;  and  many  forms 
of  exercise  may  be  accomplished  with  them  all. 
For  the  relief  of  partial  disabilities  or  of  the 
weakening  of  certain  portions  of  muscles,  as  the 
result  of  an  injury,  it  is  not  too  much  to  say  that 
they  all  conspicuously  fail  of  attaining  the  objects 
for  which  they  are  supposed  to  be  required.     A 


EXERCISES  IN  AFTER  TREATMENT  49 

muscle  which  has  suffered,  let  us  say  a  laceration 
of  a  few  of  its  fibres,  and  which  in  consequence  of 
that  laceration  has  been  permitted  to  'rest,'  or  in 
other  words,  to  undergo  wasting  for  some  indefinite 
period  of  time,  is  left  in  a  state  of  general  debility, 
which  is  accentuated  with  reference  to  some 
particular  direction  of  movement ;  that  is  to  say, 
with  regard  to  any  in  which  the  lacerated  fibres,  if 
sound,  would  be  called  upon  to  take  a  prominent 
part. 

"  Let  it  be  assumed  that  the  laceration  has  occurred 
to  a  few  fibres  of  the  deltoid,  and  that  the  arm  has 
been  kept  in  a  passive  condition.  The  power  of 
raising  it  will  be  altogether  impaired ;  but  it  will 
depend  on  the  position  of  the  lacerated  fibres 
whether  the  impairment  will  be  more  conspicuous 
in  direct  raising,  or  in  raising  with  an  inclination 
backwards  or  forwards.  Whichever  it  may  be,  the 
movement  which  occasions  pain  will  not  only  be 
avoided,  but,  whenever  circumstances  call  for  any 
approach  to  it,  the  stronger  portions  of  the  muscle 
will  be  thrown  on  guard,  so  to  speak,  for  the  express 
purpose  of  protecting  the  weaker  parts  from  being 
employed.  If  the  patient  be  made  to  grasp  a 
suitable  ring  or  handle,  to  which  is  attached  a  cord 
running  over  a  pulley  fixed  above  the  head  and 
carrying  a  light  weight,  say  of  two  pounds  or  so,  at 
its  other  extremity,  and  is  directed  to  draw  up  the 
weight  as  far  as  may  be  convenient,  and  then  let  it 


50  EXERCISES  IN  AFTER  TREATMENT 

return  gently  to  its  position,  doing  this  again  and 
again,  a  very  different  effect  will  be  produced.  If 
the  patient  commence  with  his  arm  raised  as  high 
as  possible,  its  descent  under  the  influence  of  its  own 
gravity,  or  the  mere  cessation  of  the  effort  to  keep 
it  elevated  will  suffice  to  draw  up  the  suspended 
weight;  and  as  this  sinks  to  return  to  its  original 
position,  the  arm  will  again  be  almost  unconsciously 
raised  and  the  deltoid  will  be  more  and  more  brought 
into  play  and  exercised,  without  any  strain  at  which 
its  specially  weakened  portion  can  take  alarm.  This 
specially  weakened  portion,  indeed,  will  find  itself 
at  work  before  it  is  aware,  and  will  be  cheated,  so 
to  speak,  into  constantly  increasing  participation  in 
the  effort  of  the  muscles  as  a  whole.  If  the  weight 
were  a  heavy  one,  or  if  an  attempt  were  made  to  lift 
a  dumb-bell  or  a  club,  no  similar  effect  would  be 
produced  ;  and  if  the  patient  were  directed  to  draw 
down  the  lower  handle  of  an  india-rubber  band,  this 
would  offer  a  constantly  increasing  resistance  to  its 
new  elongation  and  would  tend,  whenever  the  down- 
ward pull  ceased  to  take  the  arm  up  with  a  jerk,  to 
harass  the  deltoid  instead  of  beguiling  it.  The 
principle  thus  laid  down  is  of  universal  application 
in  such  cases,  and  a  few  days  will  generally  suffice 
to  bring  the  specially  weakened  portions  of  the 
muscle  into  line  with  the  remainder,  and  to  get  rid 
of  any  pain  which  the  earlier  efforts  may  have  caused. 
When  this  has  been  accomplished  the  muscle  may 


EXERCISES  IN  AFTER  TREATMENT  51 

be  exercised  more  freely,  and  as  a  whole,  and  the 
weights  employed  may  be  increased.  All  that  is 
necessary  in  the  first  instance  is  so  to  arrange  the 
exercises  as  to  furnish  a  movement  in  which  the 
weakest  part  of  the  affected  muscle  must  take  its 
share,  and  to  do  this  in  such  manner  that  the  move- 
ment in  question  is  started  and  in  its  course  is 
facilitated  by  the  descent  of  the  weight  which  the 
opposite  action  has  drawn  up." 

Dr.  Wharton  Hood  then  goes  on  to  discuss  these 
principles  as  applied  to  the  muscles  of  the  leg: — 

"  The  first  exercises  should  be  made  by  attaching 
to  the  ankle  a  band,  from  the  inner  side  of  which,  at 
the  level  of  the  malleolus,  a  cord  passes  under  a 
pulley  a  little  above  the  level  of  the  floor,  ascends 
some  five  or  six  feet,  passes  over  another  pulley,  and 
then  descends,  carrying  an  appropriate  weight.  The 
patient  being  seated,  and  the  cord  taut,  he  makes  a 
movement  of  abduction  of  the  leg,  drawing  the 
weight  up  as  he  does  so,  and  when  he  has  accom- 
plished what  he  can  in  this  direction,  he  allows  the 
action  to  be  reversed,  and  is  assisted  to  assume  a 
position  of  adduction  by  the  weight  as  it  descends. 
In  this  way  the  adductor  muscles  are  gently  stimu- 
lated into  renewed  activity,  the  natural  range  of 
movement  is  soon  restored,  and  is  accomplished 
without  the  pain  which  previously  attended  all 
efforts  in  this  direction.  The  exercise  may  soon  be 
varied  and  the  weight  increased,  as  strength  is  gained, 


52  EXERCISES  IN  AFTER  TREATMENT 

and  at  the  discretion  of  the  surgeon  ;  and  as  soon 
as  the  thigh  is  restored  to  the  same  measurement  as 
its  fellow  the  cure  may  be  regarded  as  complete. 

"It  is  manifest  that  by  means  of  an  ankle  band 
or  stirrup,  to  which  a  cord  is  attached,  and  by  the 
combination  of  two  or  three  pulleys,  every  possible 
movement  of  the  lower  extremities  maybe  performed 
against  the  pull  of  the  weight,  and  reversed  with 
assistance  from  it  as  it  descends  ;  and  that  the 
exercises  may  be  accomplished  in  either  a  sitting  or 
a  standing  posture.  The  surgeon  has  first  to  con- 
sider what  movement  it  is  that  the  patient  is  least 
able  to  perform,  and  to  arrange  the  contrivance  in 
such  a  manner  that  this  movement  shall  be  assisted 
by  the  weight  as  it  returns  to  the  position  from 
which  it  has  been  raised  by  the  antagonistic  move- 
ment. The  same  applies  to  all  muscles  of  the  arms 
and  trunk  (handles  being  substituted  for  the  anklets) 
with  the  exception  of  flexion  and  extension  of  the 
hands  by  the  muscles  of  the  forearm.  For  these, 
the  best  contrivance  is  a  roller  of  such  diameter  that 
the  fingers  will  close  round  it  comfortably,  fixed  at 
a  convenient  height  and  furnished  at  one  end  with 
a  ratchet  that  can  be  released,  and  at  the  other  with 
a  cord  carrying  a  weight,  and  so  arranged  as  to  coil 
round  the  roller  as  it  is  turned.  The  roller  should 
then  be  grasped  overhand  for  the  exercise  of  the 
flexers,  and  underhand  for  the  exercise  of  the 
extensors,  and  slowly  turned  until  the  weight  is 


EXERCISES  IN  AFTER  TREATMENT  53 

completely  wound  up,  when  the  ratchet  may  be 
released  and  the  weight  either  suffered  to  run  down 
or  controlled  in  its  descent  by  muscular  effort." 

In  addition  to  the  employment  of  exercising  on 
these  lines,  great  advantage  can  be  obtained  by 
prescribing  swimming,  especially  in  cases  of  the 
back  and  hip  joint.  "  The  water  buoys  up  the 
affected  limb,  and  renders  its  movements  com- 
paratively easy." 

There  are  several  machines  on  the  market 
working  on  the  principles  Dr.  Hood  describes, 
which  are  sold  with  a  chart  of  the  different  exer- 
cises for  each  limb.  The  medical  man,  at  the 
commencement,  should  attend  the  first  few  per- 
formances with  the  object  of  selecting  the  most 
suitable  movements  and  regulating  the  amount  of 
weight  to  be  used.  At  the  start  it  will  be  found 
advisable  to  begin  with  a  light  weight  and  a  small 
number  of  each  individual  movement.  As  the 
muscles  improve  in  strength  and  agility,  the  number 
of  movements  may  be  increased,  but  no  increase 
should  be  made  in  the  weight  till  at  least  a  week 
has  elapsed.  In  addition  to  the  performance  of 
these  exercises,  patients  with  marked  disability 
may  be  instructed  to  persevere  in  certain  motions 
which  will  help  the  restoration  of  mobility  by  the 
voluntary  stretching  of  their  muscles.  In  the  case 
of  a  shoulder  the  patient  should  stand  facing  a 
door,  placing  both  hands  on  it  he  has  gradually  to 


54  EXERCISES  IN  AFTER  TREATMENT 

creep  up  higher  by  the  purchase  obtained  by  his 
fingers.  This  should  be  done  daily  till  the  injured 
limb  can  reach  as  high  up  the  door  as  its  fellow. 
When  this  can  be  accomplished  with  ease,  he  may 
seize  the  top  of  the  door  with  the  hand  of  the 
unsound  arm,  and  by  the  gradual  bending  of  the 
knees  regulate  the  stretching  of  his  muscles. 
Where  a  knee  is  stiff,  the  patient,  facing  the  wall, 
should  place  the  foot  of  the  injured  side  touching 
and  at  right  angles  to  the  wainscoting.  Then,  with 
the  sound  leg  regulating  the  amount  of  strain, 
strive  to  make  the  injured  knee  touch  the  wall. 
As  soon  as  this  can*  be  done  the  foot  may  be 
withdrawn  a  few  inches  from  the  wall,  and  further 
efforts  made  to  touch  the  wall  with  the  bending 
knee.  The  movement  is  practically  the  same 
action  as  "the  lunge"  in  fencing,  and  it  is  essential 
that  the  sole  and  heel  of  the  affected  limb  be  kept 
flat  on  the  ground  in  its  performance,  as  the  lifting 
of  the  heel  masks  the  bending  of  the  knee.  Where 
the  actions  of  supination  and  pronation  are  defec- 
tive in  an  elbow  or  wrist,  a  can  of  water  is  seized 
by  the  handle  and  efforts  made  to  twist  it  first  to 
the  right  and  then  to  the  left.  The  momentum  of 
the  swinging  can  accentuates  the  voluntary  action 
of  the  muscles  and  helps  to  stretch  those  opposed 
to  the  movement.  Some  variations  and  additions 
will  doubtless  occur  to  medical  men  when  dealing 
with    cases   where    some    voluntary   stretching   is 


6 

s_ 
cd 
Q 


EXERCISES  IN  AFTER  TREATMENT  55 

desirable,  but  in  which  the  above  movements  are 
not  quite  suitable. 

Where  the  erection  of  one  of  the  manufactured 
machines  is  impossible,  or  where  the  amount  of 
existing  disability  needs  but  a  short  period  of 
exercising,  an  efficient  apparatus  can  easily  be 
rigged  up  by  means  of  some  pulleys,  a  few  yards  of 
rope,  and  two  sand  bags  with  loops  attached.  The 
method  of  erection  can  be  best  explained  bv  the 
subjoined  diagrams. 

(1).  Arm  work.  ab  =  pulleys,  distance  apart 
equal  to  width  of  patient's  shoulders :  X  =  archi- 
trave of  doorway,  the  frame  of  the  machine  :  R  = 
ropes  joined  at  R2,  threaded  through  pulleys  a  b ; 
H  =  hook  on  which  to  hang  sandbags  :  S  =  sand- 
bags of  1 -Jibs,  each  :  E  =  handles. 

(2).  Leg  work.  a  b  c  =  pulleys  :  R  =  rope 
threaded  through  pulleys  terminating  in  the  anklet 
to  be  fixed  to  the  foot :  L  =  anklet  or  loop  for 
foot :  S  =  sandbags  2  Jibs.  each. 

The  object  of  having  two  sandbags  is  that  in 
some  exercises  a  very  much  lighter  weight  will  be 
found  necessary  than  in  others,  and  the  removal 
or  addition  of  a  second  bag  renders  this  easy  to 
manage. 

The  weight  suggested  is  about  the  average 
required  at  the  commencement  of  an  ordinary  case, 
but  the  medical  attendant  must  judge  for  himself 
the  desirability  of  either  increasing  or  lessening  the 


56  EXERCISES  IN  AFTER  TREATMENT 

amount.  A  certain  amount  of  care  in  the  adjust- 
ment will  be  necessary  to  ensure  the  smooth  running 
of  the  ropes  through  the  pulleys,  but  this  simple 
contrivance  does  admirably  as  a  substitute  for  the 
more  expensive  machines,  and  will  cost  but  a  few 
shillings. 


CHAPTER  V 

NOTES   ON   CASES 

In  the  selection  of  cases  which  illustrate  the  treat- 
ment of  the  various  conditions  described  in  the 
foregoing  pages,  a  choice  has  been  made  of  those 
where  the  disability  complained  of  was  not  very 
marked.  The  majority  had  not  only  been  under 
competent  medical  attention  at  the  time  of  the 
original  hurt,  but  had  usually  run  through  the  gamut 
of  massage,  radiant  heat,  and  ionization  in  their 
search  for  soundness.  These  slightly  impaired  j  oints 
are  typical  of  the  cases  that  throng  the  modern 
bonesetter's  consulting  room,  and  it  is  for  this  reason 
that  they  are  given  in  preference  to  the  more  marked 
cases  of  ankylosis.  Generally  speaking,  when  after 
a  reasonable  time  has  elapsed,  a  patient  fails  to 
regain  complete  freedom  of  action  and  pain  in  an 
injured  limb,  medical  men  would  do  well  to  assist 
recovery  by  treatment  based  on  these  lines,  instead 
of  trusting  to  the  further  continuance  of  the  more 
usual  remedies.  Granted  that  time  and  patience  in 
a  large  number  of  cases  may  bring  restoration  to  the 
normal,  still  this  treatment  undoubtedly  expedites 
recovery,  and  would  probably  satisfy  the  patient 


58  NOTES  ON  CASES 

and  his  friends  that  the  advice  of  a  bonesetter  was 
not  required.  Amongst  the  following  cases  will  be 
found  examples  of  what  can  be  done  where  impair- 
ment has  been  due  to  injury  of  the  soft  parts  by 
bullets.  The  very  successful  issue  in  each  of  the 
three  cases  treated  in  this  way  may  possibly  be  of 
assistance  to  those  who,  at  this  time,  are  engaged  in 
looking  after  our  convalescent  soldiers. 

A.  C.     Male,  cetat  62.     Traumatic  Lumbago. 

Six  months  ago,  playing  golf,  sprained  the  back  when 
driving.  Pain  became  so  acute  he  returned  home.  Bella- 
donna plaster  was  applied.  The  acute  pain  passed  off  in 
the  course  of  a  few  days,  but  had  noticed  a  certain 
amount  of  discomfort  ever  since.  Recently  has  been 
out  shooting,  and  the  walking  has  caused  the  pain  to 
return.  Treatment  has  been  given  for  rheumatism  and 
lumbago,  medicinally  and  locally.  Lumbar  muscles  on 
the  right  side  crampy  and  stiff.  Difficulty  in  bending 
down  to  lace  boots.  Operated  upon,  lumbar  muscles 
stretched,  followed  by  rubbing  one  week,  exercises  four- 
teen days.     Discharged  cured. 

Mrs.  L.     Adhesions  shoulder. 

Two  months  ago  fell  over  a  strand  of  wire  on  to  left 
shoulder.  Very  painful.  Impacted  fracture  head  of 
humerus  seen  under  radiograph.  Was  kept  absolutely 
quiet  for  three  weeks  and  then  massage.  Shoulder  is 
now  stiff  and  painful.  Rotation  defective,  abduction 
defective.  Thickening  round  the  capsule  of  the  joint. 
Operated     on.       Rubbed     for     ten     days.       Exercises 


NOTES  ON  CASES  59 

commenced  and  rubbing  continued.  Three  weeks  later 
thickening  nearly  all  gone,  still  slightly  painful  at  the 
anterior  aspect  of  the  joint  and  in  the  upper  part  of  the 
coracobrachialis.  Rubbing  for  another  week  and  to 
exercise  at  home.  Received  letter  week  later  practically 
sound. 

Mrs.  G.  W.     Ankle-joint  Adhesions. 

Three  years  ago  fractured  both  bones  of  the  left  ankle. 
Again  fell,  refractured  a  year  later.  Splints  and  rest  for 
seven  weeks.  Massage  was  commenced  fairly  early  and 
continued  for  eight  weeks.  Still  complains  great  pain  on 
walking,  and  has  never  felt  sound  on  the  foot.  Rest  has 
been  prescribed  and  tried  on  several  occasions  with  no 
result.  Movements  of  the  foot  on  careful  examination 
were  found  to  be  slightly  defective,  both  in  extension 
and  flexion,  on  comparison  with  the  uninjured  limb. 
Was  operated  on,  rubbing  for  ten  days.  Discharged 
perfectly  sound  and  has  remained  so. 

R.  H.     Elbow-joint  Adhesions. 

Fell  into  a  trench  four  months  ago  when  training, 
injuring  right  elbow.  Radiograph  shows  slight  injury 
condyle  of  the  humerus.  Massage  was  tried  and  got 
better.  Then  was  ordered  to  France.  When  there 
found  he  was  unable  to  use  arm  without  great  pain, 
so  returned  home  for  advice.  Still  complains  of  joint 
being  weak  and  painful.  Extension  defective,  supination 
almost  entirely  lost.  Biceps  very  contracted.  Operated 
upon.  Massage  and  exercises.  Returned  to  the  front 
perfectly  sound  within  fourteen  days  of  the  operation. 


60  NOTES  ON  CASES 

Miss  M.  B.     Adhesions  tarso-metatarsal  joint 

Seven  weeks  ago  sprained  right  ankle.  Saw  her  medical 
attendant,  who  strapped  the  joint,  and  she  was  able  to 
potter  about.  Five  weeks  later,  though  all  swelling  had 
disappeared,  pain  continued  in  the  front  of  the  foot. 
Consulted  well  known  orthoposdic  authority,  who  ordered 
pad  and  alteration  to  the  boot.  A  radiograph  which  was 
taken  was  negative.  Pain  is  still  present  on  movement, 
and  she  still  walks  lame.  Mobility  of  the  tarso-meta- 
tarsal joints  defective.  Operation  followed  by  massage. 
Perfectly  sound  within  two  weeks  and  has  remained  so. 

K.  I.     Female.     Contracted  Muscles. 

A  year  ago,  skating,  sprained  inner  side  of  the  right 
thigh  high  up.  Elastic  bandage  applied  and  rest  enjoined. 
Complains  of  great  weakness  in  the  thigh  and  pain  on 
use.  The  adductor  tendons  found  to  be  crampy  and 
contracted.  Abduction  painful  and  limited.  Muscles 
stretched  under  anaesthetic.  Rubbing  and  exercises. 
Received  a  letter  in  a  month's  time  absolutely  sound. 

H.  B.     Male.     Contracted  Muscles. 

Hacking  two  years  ago  sprained  inside  of  the  right 
thigh.  Laid  up  for  fourteen  days  with  home  treatment 
of  rubbing  in  liniment.  Abstained  from  riding  that  year. 
Hunting  the  following  year  the  thigh  went  again.  Rested 
for  two  months.  Went  out  hunting  again,  and  the  thigh 
went  again.  Six  weeks  later  tried  riding,  thigh  went 
again.  Has  been  wearing  a  Salmon's  riding  belt  with 
no  relief.  Adductor  muscles  found  wasted  and  crampy. 
Abduction  painful  and  limited.    Operated  upon.    Massage 


NOTES  ON  CASES  61 

and  exercises.     This  patient  has  hunted  regularly  with- 
out further  trouble  for  the  past  five  years. 

S.  B.     Male.     Hip-joint  Adhesions. 

Two  months  ago  walking  slipped  off  the  curb.  Some- 
thing went  in  the  left  hip-joint,  not  badly,  but  it  was  very 
painful  for  a  few  minutes.  He  took  no  notice,  but  con- 
tinued to  use  it  freely.  Two  weeks  later  walking  over 
rough  ground  out  fishing,  became  much  worse.  Treat- 
ment has  been  spasmodic  resting,  but  the  condition  is 
worse  than  ever.  Radiograph  shows  early  arthritis.  All 
movements  of  the  hip  are  imperfect,  distinctly  painful 
spot  in  the  centre  of  the  groin  over  the  ilio  femoral  band. 
Operated  upon.  Massage  and  exercises.  Month  later 
perfectly  sound  and  has  remained  so. 

P.  C.     Male.     Traumatic  Lumbago. 

Four  months  ago  horse  fell  backwards  on  him.  Right 
side  of  the  back  being  severely  bruised.  Rested  off  and 
on,  and  acute  condition  soon  passed  away.  Pain  still 
present  on  certain  movements,  greatly  accentuated  by 
any  violent  exercise,  such  as  tennis  or  riding  a  rough 
horse.  Has  been  advised  to  rest  for  six  months. 
Muscles  in  the  right  lumbar  region  contracted  and 
tender.  Movement  of  bending  and  rocking  to  the 
left  defective.  Operated  upon.  Massage,  exercises, 
swimming.     Perfectly  sound  within  three  weeks. 

R.  D.  M.     Male.     Belgian.     Elboiv-joint  Adhesions. 
Shot  through  the  fore  arm  and  upper  arm  in  early 
October.     Fracture  of  the    radius.     Treated  in  hospital 


62  NOTES  ON  CASES 

abroad  and  in  England  till  wound  healed.  Has  been 
discharged  by  the  Belgian  authorities  from  hospital  as  a 
reforme  soldier.  Inability  to  extend  or  flex  elbow  joint 
without  great  pain.  Supination  and  flexion  defective. 
Operated.  Massage  and  rubbing.  Discharged  cured, 
after  three  weeks. 

A.  B.     Belgian.     Ankle-joint  Adhesions. 

Shot  through  the  right  ankle  joint  middle  of  October. 
Treated  in  hospital  abroad  and  in  England.  Discharged 
by  Belgian  authorities  as  a  reforme  soldier.  Wishes  to 
go  to  Spain  to  take  up  post  of  chauffeur.  Is  still  on 
crutches.  Unable  to  extend  foot  without  severe  pain  or 
bear  least  weight  on  it.  Bullet  wound  still  unhealed, 
having  had  no  medical  attention  for  fourteen  days.  Foot 
flexed  and  rigid.  Treated  bullet  wound  by  dry  dressings 
and  bandage.  Healed  at  the  end  of  a  fortnight.  Week 
later  operated  under  an  anaesthetic.  Freely  moved  the 
foot  and  ankle.  Followed  by  massage.  At  the  end  of 
three  weeks  was  able  to  walk  freely  and  painlessly  with 
perfect  movement  of  joint  without  any  support.  Has 
left  England. 

T.  J.     Hip-joint  Adhesions. 

Six  months  ago,  in  Belgium,  received  a  bullet  wound 
through  the  left  buttock ;  exit  in  the  left  groin ;  the 
bullet  passed  through  the  right  testicle  and  embedded 
itself  in  the  right  thigh.  Right  testicle  removed  by 
operation  and  bullet  extracted  from  thigh. 

Wounds  were  healed  five  months  later,  and  patient 
was  discharged  from  hospital.  Unable  to  walk  without 
intense  pain  in  the  left  thigh  and  groin.     Movement  very 


NOTES  ON  CASES  63 

defective  in  the  hip  joint;  flexion  markedly  so;  abduction 
and  rotation  slightly.  Has  been  discharged  by  the 
Belgian  authorities  as  a  reforme  soldier.  Manipulated, 
and  massage  prescribed.  Five  days  later  walked  to  my 
house,  a  distance  of  four  miles,  free  from  pain.  Move- 
ment greatly  improved.  Exercises  ordered.  Seen  week 
later,  is  now  practically  sound. 

A.  G.     Hip  joint 

Slipped  and  fell  nine  months  ago  on  to  left  hip,  which 
was  severely  bruised.  Kept  quiet  with  local  applications 
of  hot  stoups.  Since  then  has  never  been  free  of  pain, 
which  occasionally  runs  down  the  thigh.  Complains 
also  of  a  sensation  of  stiffness  in  the  joint.  Has  received 
massage  and  heat.  The  patient  is  a  stout  man  with  an 
alcoholic  tendency.  Abduction,  flexion,  extension,  and 
rotation  limited  and  slightly  painful,  increasing  if  move- 
ment is  persevered  with.  Was  operated  upon,  massage 
and  exercises.     Good  result. 

A.  W.     Nipped  Membrane  and  Adhesions. 

Six  weeks  ago  fell  at  tennis,  slightly  spraining  the  right 
knee,  but  continued  playing  for  two  hours.  The  knee 
then  became  very  painful  and  swollen.  Saw  his  medical 
man.  Rest  prescribed,  local  application  of  ice.  Next 
day  hot  water  fomentations  were  ordered  and  continued 
for  ten  days.  Still  unable  to  get  about  without  dis- 
comfort in  the  joint.  On  examination  slight  synovial 
thickening  detected.  Full  extension  of  the  joint  imper- 
fect, and  pain  on  pressure  over  inner  condyle.  Muscles 
wasted  1)4   inches.     Diagnosis,  nipped  membrane  and 


64  NOTES  ON  CASES 

adhesions  round  the  internal  lateral  ligament.  Operated 
upon;  rubbing  and  exercises  for  three  weeks.  Perfectly 
sound. 

R.  H.  Adhesions  in  Finger. 
Five  months  ago  twisted  the  right  forefinger  in  a 
door.  Severe  pain.  Saw  his  medical  man.  Splints  were 
ordered  and  ointment  rubbed  in.  Fortnight  later  saw 
surgeon  in  consultation.  Massage  and  radiant  heat  pre- 
scribed. After  a  week  or  so  treatment  was  stopped,  and 
he  went  abroad.  Became  rapidly  worse,  and  at  Monte 
Carlo  saw  medical  man,  who  prescribed  Bengue's  anes- 
thol.  Consulted  another  medical  man,  who  ordered 
supphaqua  baths.  Index  finger  middle  joint  rigid,  shiny, 
painful.  Slight  rocking  movement.  Operated  on.  Mass- 
age for  two  weeks  and  roller  exercises.  End  of  month 
perfectly  sound. 

Mrs.  N.     Elderly  Lady  with  Rheumatic  History. 
A  dh  esions  Wrist  Joint. 

About  six  months  ago  right  wrist  became  painful  to 
use.  Saw  her  medical  attendant  and  was  ordered  to 
Droitwich.  Massage  prescribed,  but  the  pain  was 
increased.  Radiant  heat  and  ionization  also  tried  with- 
out effect.  Radiograph  negative.  Slight  interference 
with  normal  action  of  wrist  and  pain  over  external 
lateral  ligament,  with  thickening  round  the  tendon 
sheaths.  Manipulated  under  an  anaesthetic  and  rubbing 
ordered.     When  last  seen  had  lost  all  pain  in  the  wrist. 

Miss  H.     Metatarsalgia  due  to  Adhesions. 
Eight  months  ago  pain  in  right  foot.     Saw  doctor,  who 
ordered  rest  for  a  fortnight.    Then  massage  was  prescribed, 


NOTES  ON  CASES  65 

and  after  pottering  about  for  five  weeks  went  to 
Smedleys,  where  improvement  took  place.  Three  months 
ago  the  foot  became  worse.  Diagnosis  of  "flat-foot" 
was  made  and  boots  altered  for  correction.  Further 
treatment  at  Llandridod  with  no  benefit.  Still  very 
lame.  Pain  most  marked  over  third  metatarso-phalangeal 
joint,  which  is  thickened  and  stiff.  Foot  manipulated, 
treated  by  massage  and  strapping  the  front  of  the  foot. 
Got  quite  well,  wearing  normal  boots. 

Miss  P.     Hip  joint. 

Two  years  ago,  whilst  doing  physical  culture  exercises, 
sudden  pain  in  right  hip  joint.  In  the  course  of  a  few 
days  consulted  her  medical  man.  Electrical  treatment 
and  medicine  prescribed  for  sciatica.  •  Pain  still  continues 
on  exercise.  On  examination  the  following  movements 
were  found  defective  and  painful,  flexion,  external  rota- 
tion, and  abduction.  Radiograph  was  negative.  Hip 
joint  manipulated  under  ether.  Freedom  from  pain 
noticed  immediately  afterwards.  Rubbing  and  exercises 
soon  established  permanent  soundness. 

Miss  E.     Shoulder  joint. 

Sprained  right  shoulder  six  months  ago  lifting  window, 
no  treatment,  but  spared  the  arm  for  a  few  days.  Pain 
has  never  entirely  gone,  and  the  last  few  weeks  has  been 
getting  worse  and  wakes  her  at  night.  Inability  to  place 
hand  behind  back.  Abduction  also  defective.  During 
manipulation  adhesions  felt  to  yield  during  rotation. 
Rubbing  and  exercises  completed  the  cure. 


66  NOTES  ON  CASES 

Miss  D.  Coccygodynia. 
Four  months  ago  noticed  pain  in  coccygeal  region  after 
riding  a  bicycle.  Pain  noticed  to  come  on  after  and 
whilst  sitting.  Pain  at  stool  only  felt  when  constipated. 
Has  been  getting  much  worse  and  now  complains  of 
pain  in  lumbar  muscles  as  well.  Radiograph  negative. 
Has  been  receiving  treatment,  hot  fomentations,  and 
latterly  morphine  suppositories.  Under  ether  the  coccyx 
was  found  stiff.  Free  movement  was  given  and  after- 
wards massage.  Coccygeal  pain  rapidly  decreased,  but 
the  pain  in  the  lumbar  region  remained.  Exercises 
ordered.  A  letter  received  two  months  later  asks  for 
permission  to  play  tennis,  saying,  "  My  back  is  now  very 
much  better,  and  I  have  little  or  no  pain." 

Mr.  C.  Shoulder  joint. 
Threw  a  stone  four  months  ago,  acute  pain  in  right 
shoulder  lasting  but  a  few  minutes.  Has  never  quite 
recovered  since,  attempts  to  use  shoulder  freely  bring  on 
the  pain.  Has  tried  rest,  massage,  and  medicinal  treat- 
ment for  rheumatism.  Joint  moved  under  ether,  rubbing 
and  exercises  ordered.  Returned  home  at  the  end  of 
ten  days  and  got  speedily  sound. 

Major  B.  Wrist. 
Three  months  ago  back  fire  starting  car,  sustained 
fracture  left  radius  with  slight  displacement.  Splints  one 
month,  since  then  home  treatment  of  rubbing  and  use. 
Still  stiff  and  painful.  Supination  and  pronation  defec- 
tive. Moved  under  ether,  movements  rapidly  became 
freer  and  less  painful.  Patient  discontinued  treatment 
early,  and  after  history  is  not  known. 


NOTES  ON  CASES  67 

Mr.  P.     Flat  foot,  so-called. 

Acute  rheumatism  two  years  ago  affecting  both  feet. 
Never  been  able  to  walk  without  pain  since.  Under 
general  rheumatic  treatment  has  improved,  but  feet 
remain  painful  on  use.  Has  received  radiant  heat  and 
has  been  wearing  valgus  pads  on  both  boots.  Feet  rigid 
and  move  en  bloc  from  ankle  joint.  Free  movement 
under  an  anaesthetic,  and  rubbing  ordered.  Mobility  at 
once  restored,  and  within  two  days  patient  was  able  to 
walk  for  some  hours  before  onset  of  discomfort  or  pain. 
Feet  were  strapped,  whilst  the  inner  side  of  the  boots  was 
being  slightly  raised  and  pads  removed.  Can  now  walk 
freely  and  comfortably. 


I.     Hand  Grasp  for  Lateral  and  Circumductory  Movements  of  Wrist. 


2.     Hold  for  Flexion  and  Extension  of  Wrist. 


3.     Hold  at  Completion  of  Flexion  of  Elbow  Joint  and  Preparatory 
to  Extension. 


4      Hold  during  Extension  of  Elbow — Note  Thumb  Pressure  over 
Head  of  Radius. 


5.     Rotation  of  Head  of  Humerus  with  Right  Hand,  Left  Hand 
holding  the  Joint. 


6.     Hand  slid  up  for  Short  Lever,  bringing  Arm  across  the  Chest. 


7.    Right  Hand  pushing  against  Scapula  during  Abduction  of  Arm. 


'Ann  having  been  Rotated  Outwards,  is  now  brought  up  above 
Level  of  Head. 


9.    Placing  Arm  behind  the  Back — Note  Left  Thumb  pressed  over 
Head  of  Biceps. 


10.     Grasp  of  Hands  for  Knee  Joint,  Patient's  Foot  between  Operator's 

Thighs. 


II.     Flexion  of  Knee  Joint  by  Bending  of  Operator's  Knees. 


12.     Flexion  of  Hip  Joint  in  Traumatic  Lumbago— Left  Hand  steadying 

the  Pelvis. 


13-     Both  Thighs  Flexed  and  pushed  on  to  Chest  Wall. 


* 


14.     Completion  of  Thrust  Back  for  Extension  of  Spine  by  the  Right 
Hand— The  Left  Hand  pressing  acting  as  the  Fulcrum. 


15-     Grip  of  the  Foot  in  Tarso-Metatarsal  Adhesions- 
of  Right  Thumb. 


-Note  Position 


'■-  :hi4^^^':'Mv  r 

ITW 

^^^^mm^ 

V  s™  «  : 

16. 


Position  of  Patient  in  Posture  Exercises  for  Voluntary  Stretching 
of  Shoulder. 


17-    First  Position  of  Posture  Exercise  for  Bending  Knee  Joint. 


18.    Second  Position. 


INDEX. 


Abduction  and  rotation,  actions  of, 

41 

defective,  27,  58,  65 

flexion,  extension  and  rotation, 
limited,  63 

movements,  defective   external 
rotation  and,  65 
Accidents,  common,  25 

to  wrist  joint,  35 
Achillis,  tendo,  15,  37 
Action  of  muscles,  voluntary,  47 
Actions  of  abduction  and  rotation, 

41 

Actions  of  supination  and  prona- 
tion, defective,  54 

and  pronation  of  hand,  35,  36 
Acute  pain  of  shoulder,  27,  66 
rheumatism,  67 
traumatic  synovitis,  31 
Adduction,  limited,  60 
Adductor  muscle  of  thigh,  15 
muscles,  41,  51 
tendons,  contracted,  60 
Adhesions,  3,  13,  14,  16,  18,  20,  26, 
35,65 
ankle-joint,  36,  59,  62 
breaking  down,  9,  16,  17 
bursa  of  deltoid,  27 
connected  with  tendons,  23 
elbow-joint,  29, 59,  61 
fibrous,  2,  10,  12 
formation  of,  II 
hip-joint,  61,  62,  63 
in  capsule  of  hip-joint,  39 
faulty  flexion,  37 
finger,  64 
muscles    surrounding  hip, 

39 
rupture  of,  40 
posterior  and  inferior  folds 
of  capsular  ligament,  26, 
27 
tendons  round  malleoli,  37 
knee-joint,  31 

manipulations    for  rupture  of 
small,  33 


Adhesions,  method  of  manipulating 
shoulder,  27,  28 

metatarsalgia  due  to,  64 

nature  of,  8 

nipped  membrane  and,  63 

of  muscles  and  tendons,  1 5 

tendon  sheath  of  head  of  bi- 
ceps, 27 

pain  and  stiffness  after,  44 

periarticular,  13,  23 

possible  presence  of,  22 

rupture  of,  16,  19,  21 

shoulder,  24,  25,  58 

tarso-metatarsal  joint,  60 

usual  sites  of,  14 

wrist  joint,  64 
Adjustment  of  apparatus,  care  neces- 
sary in,  56 
Adventitious  band,  25 
After-care  of  cases,  47 
After-pain,  18,  19 
After-treatment,  16,  33 

exercises  in,  47 
Anaesthesia,  27,  29 

examination  under,  40 
„        manipulations    of   ankle-joint 
under,  37 
Anaesthetic,  16,  20,  21 

manipulation  under,  64 

movement  under,  40,  43,  67 
Anaesthetics,  17 
Anatomical  displacement,  4 
Ankle-band,  51,  52 
Ankle-bones,  fracture  of,  59 

refracture  of,  59 
Ankle-joint  adhesions,  36,  59,  62 

injury  to,  36 

manipulations  of,  under  anaes- 
thesia, 37 

shot  through,  62 
Ankylosed  joints,  10,  16 
Ankylosis,  2,  3,  57 

complete,  13,  25 

of  hip,  manipulations  for,  41 

pathology  of,  12 
Annular  ligament  of  wrist,  15 


69 


INDEX 


Antero-posterior  movements,  26 
Apparatus,  efficient  exercising,  55 
Arms  and  trunk,  muscles  of,  52 
Arthritic  changes  of  the  bone,  22 

conditions,  treatment  of,  40 
Arthritis,  61 

rheumatoid,  12,  14,  39,  40 
Articulations  of  impeded  metacar- 
pal bones,  36 

treatment,  36 

rigid  digital,  36 
Asperin,  20 
Average  weight  required,  55 

Back,  sprain  of,  44 

and  hip  joint,  swimming  for,  53 
Bags,  hot  salt,  19 
Band,  adventitious,  25 

ankle,  51,  52 

ilio  femoral,  14 
Bands,  fibrous,  rupture  of,  17 

india-rubber,  48,  50 
Baths,  radiant  heat,  16 
Belgian,  wounded,  61,  62 
Belladonna  plaster,  58 
Bells,  dumb,  48,  50 
Belt,  Salmon's  riding,  60 
Benson  machine,  47 
Biceps,  adhesions  of  tendon  sheath 
of  head  of,  27 

contracted,  30,  59 

muscle,  29 

tendon,  25 
Bicipital  groove,  15,  28 
Bicycle  ride,  pain  in  coccygeal  re- 
gion after,  66 

vibration,  25 
Bone,  arthritic  changes  of  the,  22 

and  bone-joint  injuries,  modern 
treatment  of,  2 

"out,"  3,  4 
Bones,  ankle,  fracture  and,  refrac- 
ture  of,  59 

articulations  of  impeded  meta- 
carpal, 36 
Bonesetter,  Lancashire,  9 

modern,  57 

trade  of,  hereditary,  5,  6 
Bonesetters,  cases  cured  by,  8 
Bonesetting  and  treatment,  II 

history  of,  I 

occult  methods    of  treatment 
and,  I 

origin  of  word,  7 

Sir  James  Paget  and,  I 
Breaking  down  adhesions,  9, 16, 17 


Bullet  wound,  62 

Bullets,  injury  of  soft  parts  by,  58 
Bursa  of  deltoid,  15 
adhesions,  27 

Calf,  tennis,  1 5 
Capsular  ligament,  14 

adhesions  in  folds  of,  26,  27 

posterior  and  inferior  folds  of, 
15 
Capsule  of  hip  joint,  adhesions  in,  39 

of  joint,  thickening  of,  58 
Care    necessary  in    adjustment    of 
apparatus,  56 

of  cases,  after-,  47 
Caries  of  spine,  42 
Cartilage.displaced  semi-lunar,  33, 34 
Cases  cured  by  bonesetters,  8 

notes  on,  57 
Cause  of  disability  in  knee  joint,  34 
Changes  of  the  bone,  arthritic,  22 
Chronic  rider's  sprain,  15 

tennis  elbow,  15,  30 
Cin,  Regina  dal,  10 
Clarke,  Dr.  Bruce,  8 
Clubs,  48 

Coccygeal  region,  pain  in,  after  bi- 
cycle ride,  66 

when  constipated,  66 
Coccygodynia,  45,  66 

manipulative  treatment  in,  45,46 

massage  in,  46 

pain  of  defcecation  in,  45 
Coccyx,  deflected,  46 

examined  under  ether,  66 

removal  of,  45 
Colles'  fracture,  35 
Column,  manipulation  of  spinal,  42 
Common  accidents,  25 
"Compleat  Bonesetter,"  6 
Complete  ankylosis,  1 3,  25 
Condition  and  tone  of  muscles,  24 
Conditions,  arthritic,  treatment  of, 

40 
Condyle,  external,  28 

inner  pain  on  pressure  of,  63 

internal,  14, 15 
Contracted  adductor  tendons,  60 

biceps,  30,  59 

extensor  femoris,  33 

lumbar  muscles,  61 

muscles,  29, 60 

wasted  and,  20, 28 
Contraction,  29 

of  muscles,  18 
and  pain,  26 


70 


INDEX 


Culture  exercises,  pain  from  physi- 
cal, 65 

Cure  of  acute  traumatic  synovitis, 
treatment  and,  31 

Cured  by  bonesetters,  cases,  8 

Defect  or    displacement  of  verte- 
brae, manipulations  of  spine  for,  43 
Defective  abduction,  27,  58,  65 

actions  of  supination  and  pro- 
nation, 54 
extension,  59 

joints  commonly  met  with,  14 
mobility  of    tarso    metatarsal 
bones,  38 
satisfactory  results  of  man- 
ipulations, 38 
motions,  26 
movement,  30,  62 

in  hip  joint,  63 
movements  of  eversion  and  in- 
version, 37 

of  flexion  and  extension,  35 
rotation,  58 

supination  and  flexion,  62 
pronation,  66 
Deficiency  of  mobility,  39 
Deflected  coccyx,  46 
Defcecation  in  coccygodynia,  pain 

in,  45 
Deltoid,  bursa  of,  1 5 
adhesions,  27 
fibres,  laceration  of,  49,  50,  51 
Derangement  of  knee  joint,  inter- 
nal, 33 
Description  of  treatment  of  injuries, 
Wharton  Hood's,  48,49,  50,  51,52 
Determining  situation  of  pain,  23 
Diagnosis,  4 
fiat  foot,  65 
radiography  and,  5 
Disability  in  knee  joint,  cause  of,  34 
Dislocated  humerus,  reduction  of,  9 
Dislocations,  8, 24 
reducing,  9 
treatment  of,  10 
Displaced  semi-lunar  cartilage,  33, 

34 

Displacement,  anatomical,  4 

of  vertebras,  manipulations  of 

spine  for,  43 
wrist,  66 

Disuse,  foot  rigid  from,  37 

"Doctress  of  Epsom,"  6 

Driving,  golf,  58 

Droitwich,  64 


Effects  of  trauma,  II,  12 
Efficient  exercising  apparatus,  55 
Elasticity  of  muscles,  18 
Elbow,  best  way  of  restoring  supple- 
ness to,  30,  31 

chronic  tennis,  1 5,  30 

injury,  59 

joint  adhesions,  29,  59,  61 

necessary  movements,   29, 
30 
Electrical  treatment,  3 1 
Electricity,  2,  10,  12 
Epiphysis,  separating  the,  18 
Ether,  coccyx  examined  under,  66 

manipulations  under,  65 
Eversion  and  inversion,  defective 

movements  of,  37 
Examination  under  anaesthesia,  40 
Exercise,  31 

by  weights  and  pulleys,  28 

machines,  method  of  using,  53, 

54,55 
Exercises,  20,  3 1,  60,  61,  63,  66 
in  after  treatment,  47 
pain  from  physical  culture,  65 
roller,  64 

muscular,  in  treatment  of  in- 
juries, 48 
Exercising  apparatus,  efficient,  55 
Extension,  29 
defective,  59 

movements  of  flexion  and, 

35 
imperfect  joint,  63 
Extensor  femoris,  contracted,  33 
External  condyle,  28 
malleolus,  15 

rotation  and  abduction   move- 
ments, defective,  65 

Falls  on  head  and  shoulders  in  hunt- 
ing field,  43 
Faradaism,  47 
Fear  of  fracture,  21 

fracturing  neck  of  femur,  42 
Feet,  rigid,  67 
Femoral  band,  ilio,  14 
Femoris,  contracted  extensor,  33 
Femur,  head  of,  14 

fracture  of,  39 

neck  of,  fear  of  fracturing,  42 
Fibres,  laceration  of  deltoid,  49,  50, 

51 

Fibrous  adhesions,  2,  10,  12 

bands,  rupture  of,  17 
Finger,  adhesions  in,  64 


71 


INDEX 


Firmness,  grasp  of  17,  18 
Flat-foot  diagnosis,  65 

manipulating,  38 
$H5S  so-called,  67 
Flexed  and  rigid  foot,  62 
Flexion,  29,  30,  33,  37 

defective  supination  and,  62 
external    rotation  and  ab- 
duction movements,  65 
and  extension,  defective  move- 
ments of,  35 
extension  and  rotation,  limited 
abduction,  63 
Fluid,  inspissated  synovial,  35 
Folds  of  capsular  ligament,  adhe- 
sions in,  26,  27 

posterior  and  inferior,  15 
Fomentations,  hot,  16,  66 
Foot,  flexed  and  rigid,  62 
machine,  47 
rigid  from  disuse,  37 
sprain  of  sole  of,  38 
Formation  of  adhesions,  II 

osteophytic,  40 
Forcible  movements,  12,  17,23,43 

manipulation,  15 
Forearm,  rotatory  movements  of, 

30 
Fox,  Dr.  Dacre,  8,  14,  23 
Fracture.  2 
Colles',  35 
fear  of,  21 
of  ankle  bones,  59 

head  of  humerus,  impacted, 

58 
neck  of  femur,  39 
patella,  32 
radius,  61,  66 
shaft  of  ulna,  23 
Fractures,  10,  24 
Fracturing  neck  of  femur,  fear  of, 

42 
Free  movement,  33 
Freedom  from  pain,  20 
Fringe,  nipped,   of  synovial  mem- 
brane, 34 

Galvanism,  47 

Gas,  nitrous  oxide,  16 

Golf  driving,  58 

overswinging  at,  25 
Gonorrhceal  infection,  12 
Grasp,  firmness  of,  17,  18 
Groin,  14 

Groove,  bicipital,  15,  28 
Gunshot  wound,  61 


Hacking  sprain  of  thigh,  60 
Handles,  52 

Head  and  shoulders,  hunting,  falls 
on,  43 
of  biceps,  adhesions  of  tendon 
sheath  of,  27 
femur,  14 
humerus,  impacted  fracture 

of,  58 
radius,  30 
rocking  of  the,  43 
Heat,  10,  63 

radiant,  2,  57,  64,  67 
baths,  16 
Hereditary  trade  of  bonesetter,  5,  6 
Hip-joint,  39,  65 

adhesions,  39,  61,  62,  63 
defective  movement  in,  62,  63 
injury  to,  39 

swimming  for  back  and,  53 
Hip,  manipulations  for  ankylosis  of, 

41 

History  of  Bonesetting,  I 

of  lady,  rheumatic,  64 
Homoeopathy  of  Surgery,  9 
Hood,  Dr.  Wharton,  6,  7,  10,  14,  17, 

23. 
Hood's,  Dr. Wharton,  "Treatment 

of  Injuries,"  48,49,  50,  51,  52 
Hospital,  Sir  J.  Paget's  lecture  at 

St.  Bartholomew's,  I 
Hot  fomentations,  16,  66 

salt  bags,  19 
Humerus,  27 

reduction  of  dislocated,  9 
Hunting,  falls  on  head  and  shoulders, 

43 

sprain,  60 
"  Husband's  Relief,  etc.,"  The,  6 
Hutton,  2,  3,  7,  10,  17 


Ilio  femoral  band,  14 

Impacted  fracture  of  head  of  hume- 
rus, 58 

Impeded  articulation  of  metacarpal 
bones,  36 

Imperfect  joint  extension,  63 

India-rubber  bands,  48 

Infection,  gonorrhceal,  12 

Inferior  folds  of  capsular  ligament, 
posterior  and,  1 5 

Inflammation,  17 
rheumatic,  43 

Injuries,  modern  treatment  of  bone 
and  bone  joint,  2 


72 


INDEX 


Injuries,   Wharton    Hood's   treat- 
ment of,  48,  49,  50,  51,  52 
Injury  to  ankle  joint,  36 
elbow,  59 
of  lumbar  region,  44 

soft  parts  by  bullets,  58 
to  hip  joint,  39 

muscular  structures,  43 
Inner  condyle,  pain  on  pressure  of ,  63 
Inspissated  synovial  fluid,  35 
Interference  with  pronation  or  supi- 
nation, 30 
Internal  condyle,  14,  1 5 
ni  derangement  of  knee  joint,  33 
lateral  ligament,  15 
Interior  lateral  ligament,  14 
Inversion,  defective  movements  of 

eversion  and,  37 
Ionization,  57,  64 

Joint,  adhesions,  tarso-metatarsal,  60 
ankle,  adhesions,  36,  59,  62 
injury  to,  36 

manipulations  under  anaes- 
thesia of,  37 
shot  through,  62 
elbow,  adhesions,  29.  59,  61 

necessary  movements,  29, 
30 
extension,  imperfect,  63 
hip,  39,  65 

adhesions,  39, 61,  62,  63 
defective  movement  in,  62, 

63 

injury  to,  39 

swimming  for  back  and,  53 
knee,  14,  31 

adhesions,  31 
cause  of  disability  in,  34 
internal  derangement  of,  33 
manipulations   for  correc- 
tion of  lesions,  32,  33 
mechanical  obstruction  of,  20 
pain,  metatarso  phalangeal,  65 
shoulder,  movement  of,  24,  65 
sprain  of,  34 

thickening  of  capsule  of,  58 
wrist,  accidents  to,  35 
adhesions,  64 
Joints,    defective,   commonly    met 
with,  14 

metatarsal  pharyngeal,  manipu- 
lation of,  39 
moving  sprained,  9 
"    rocking  of,  30 
Jumping  off  omnibus,  25 


Knee  joint,  14,  31 

adhesions,  31 
cause  of  disability  in,  34 
internal  derangement  of, 
manipulations  for  correc- 
tion of  lesions,  32,  33 
sprain,  63 
Koeher,  9 
Kyphosis,  43 

Laceration  of  deltoid  fibres,  49,  50, 

51 
Lady,  rheumatic  history  of,  64 
Lancashire  bonesetter,  9 
Lancet*  2,  7 
Lateral  ligament,  interior,  14 

internal,  15 
Lecture  at  St.  Bartholomew's  Hos- 
pital, Sir  J.  Paget's,  I 
Leverage,  17,  18,  21 
Ligament,  capsular,  14 

adhesions  in  folds  Of,  26, 27 
posterior  and  inferior  folds 

of,  15 

interior  lateral,  14 

internal  lateral,  15 

of  wrist,  annular,  15 
Limitation  of  movement,  29 
Limited  abduction,  60 

flexion  extension  and  rotation, 

63 
Lincoln's  Inn  Fields,  6 
Llandridod,  65 
Longus,  supinator,  15 
London  Magazine,  6 
Loss  of  mobility,  3 

movement,  39 
Lost  supination,  59 
Lumbago,  traumatic,  44,  45,  58,  61 
Lumbar  muscles,  contracted,  61 
pain  in,  66 

region,  injury  of,  44 
"Lunge,"  54 

Machine,  Benson,  47 

Foot,  47 
Malleoli,  adhesions  in  tendons  round, 

37 
Malleolus,  51 

external,  1 5 
Manipulating  adhesions  of  shoulder, 
method  of,  27,  28 
flat-foot,  38 
Manipulation,  I,  2,  4,  17,  35 
forcible,  15 


73 


INDEX 


Manipulation  of  metatarsal  pharyn- 
geal joints,  39 
spinal  column,  42 
spine   for   defect  or  displace- 
ment of  vertebras,  43 
treatment  by,  12 
under  anaesthetic,  64 
Manipulations,  20,  22,  38,  63 
for  ankylosis  of  hip,  41 

correction  of  lesions,  32,  33 
rupture  of  small  adhesions, 

33 
forcible,  47 
of  ankle  joint  under  anaesthesia, 

37 
under  ether,  65 
Manipulative  treatment  in  coccy- 

godynia,  45 
Mapp,  Mrs.,  6 
Marsh,  Howard,  10 
Mason,  3 

Massage,  2,  10,  II,  12, 16,  19,  35.  47, 
57.  58,  59.  60,  61,  62,  63,  64 
in  coccygodynia,  46 
Matthews,  3 

Mechanical  obstruction  of  joint,  20 
Membrane  and  adhesions,  nipped,  63 

synovial,  nipped  fringe  of,  34 
Membranes,  synovial,  13,  22 
Metatarsal   bones,  articulation   of 
impeded,  36 

defective  mobility  of,  38 
Metatarsalgia,  39 

due  to  adhesions,  64 
Metatarso  pharyngeal  joint,  pain  in, 

65 
Method  of  manipulating  shoulder 
adhesions,  27,  28 
using  exercise  machines,  53,  54, 

55 
Methods  of  treatment,  bonesetting 
and  occult,  I 
to  remedy  wasted  muscles,  47 
Mobility,  deficiency  of,  39 

defective,   of   tarso-metatarsal 

bones,  38 
loss  of,  3 
Modern  bonesetter,  57 

treatment  of  bones  and  bone- 
joint  injuries,  2 
Morphine  suppositories,  66 
Morton,  39 

Movement,  defective,  30,  62 
in  hip  joint,  63 
free,  33 
limitation  of,  29 


Movement,  loss  of,  25,  39 
rocking,  64 
rotatory,  of  tibia,  33 
Movements,  28 

antero-posterior,  26 
defective  flexion,  external  rota- 
tion and  abduction,  65 
of  eversion  and  inversion, 

37 
of  flexion  and  extension/35 
forcible,  12,  17,  23, 43 
of  rotation,  43 
passive,  II 
rotatory,  35 

of  forearm,  30 
various,  21 
Motions,  defective,  26 
Muscle,  adductor  of  thigh,  15 
biceps,  29 
stretching, 30 
triceps,  29 
Muscles,  adductor,  41,  51 

adhesions  in  muscles  surround- 
ing hip,  39 
and  tendons,  adhesions  of,tI5 
condition  and  tone  of,  24 
contracted,  29,  60 

lumbar,  61 
contraction  of,  18,  26 
elasticity  of,  18 
lumbar,  pain  in,  66 
of  arm  and  trunk,  25 

leg,  51,  52 
relaxation  of,  16 
voluntary  action  of,  47 
wasted  and  contracted,  20,  28 
methods  to  remedy,  47 
Muscular  resistance,  16,  20,  21,  29, 

33 

structures,  injury  to,  43 

Nature  of  adhesions,  8 

Necessary    movements    of    elbow 
joint,  29,  30 

Neck  of  femur,  fear  of  fracturing, 
42 
fracture  of,  39 

Night,  pain  at,  26 

Nitrous  oxide  gas,  16 

Nipped  fringe  of   synovial    mem- 
brane, 34 

membrane  and  adhesions,  63 

Notes  on  cases,  57 

Object  of  having  two  sand  bags,  55 
Obstruction  of  joint,  mechanical,  20 


74 


INDEX 


Occult  methods  of  treatment,  bone- 
setting  and,  I 
Omnibus,  jumping  off,  25 
"On  Bonesetting— so-called,"  6 
Origin  of  word  "  Bonesetter,"  7 
Osteophytic  formation,  40 
Overhand  serving  at  tennis,  25 
Over-swinging  at  golf,  25 
Oxide  gas,  nitrous,  16 

Pads,  valgus,  67 
Paget,  Sir  James,  I,  8 

and  bonesetting,  1 

lecture  at    St.  Bartholomew's 
Hospital,  I 
Pain,  after-,  18,  19 

and  stiffness  after  adhesions,  44 

at  night,  26 

determining  situation  of,  23 

freedom  from,  20 

from  physical  culture  exercises, 

.  65 

in  coccygeal  region  after  bicycle 

ride,  66 
when  constipated,  66 
lumbar  muscles,  66 
metatarso  phalangeal  joint,  66 
of  shoulder,  acute,  27,  66 
of  defcecation  in  coccygodynia, 

45 
on  pressure  of  inner  condyle,  63 
Patella,  fracture  of,  32 
Pathology  of  ankylosis,  12 
Periarticular  adhesions,  13, 23 
Pes  valgus,  38 
Physical    culture     exercises,    pain 

from,  65 
Plaster,  belladonna,  58 
Popliteal  space,  32 
Posterior  and  inferior  folds  of  cap- 
sular ligament,  15 
Presence  of  adhesions,  possible,  22 
tubercular  trouble,  possible,  42 
Process  of  ulna,  styloid,  1 5 
Prognosis  as  to  recovery,  22 
Pronation     or     supination,    inter- 
ference with,  30 
Pulleys,  20,  47,  52,  55 

exercises  by  weights  and,  28 
Pulling,  17 

Radiant  heat,  2,  57,  64,  67 

baths,  16 
Radiograph,  21,  22,  58,  59,  60,  61, 
64,  65,  66 


Radiography,  40,  42 

and  diagnosis,  5 
Radius,  fracture  of,  61,  66 

head  of,  30 
Ratchet,  52,  53 
Recovery,  prognosis  as  to,  22 
Reducing  dislocations,  9 
Reduction  of  dislocated  humerus,  9 
Refracture  of  ankle  bones,  59 
Regina  dal  Cin,  10 
Region,  injury  of,  44 
Relaxation  of  muscles,  16 
Removal  of  coccyx,  45 
Resistance,  muscular,  16,  20,  21,  29, 

33 
Rheumatic  history  of  lady,  64 

inflammation  of  muscular  struc- 
tures, 43 
Rheumatism,  12,  14,  26,  58 

acute,  67 
Rheumatoid  arthritis,  12,  14,  39,  40, 
Rider's  sprain,  41 

chronic,  15 
Riding  belt,  Salmon's,  60 
Rigid  digital  articulations,  36 
feet,  67 

foot,  flexed  and  rigid,  62 
rigid  from  disuse,  37 
Rocking  of  joints,  30 

the  head,  43 
Roller,  15 

exercises,  64 
Rotation,  17 

actions  of  abduction  and,  41 
defective,  58 

limited  abduction,  flexion,  ex- 
tension and,  63 
movements  of,  43 
of  scapula,  26,  28 
Rotatory  movement  of  tibia,  33 
movements,  35 
of  forearm,  30 
Rubbing,  19,  24,  28,  31,  62 
Rupture  of  adhesions,  16,  19,  21 

in  muscles  surrounding  hip, 

40 
manipulations  for,  33 
of  fibrous  bands,  17 

St.  Bartholomew's  Hospital,  Sir  J. 

Paget's  lecture  at,  I 
Salmon's  riding  belt,  60 
Salt  bags,  hot,  19 

Sand  bags,  object  of  having  two,  55 
Scapula,  rotation  of,  26,  28 
Schivardi,  Dr.,  10 


75 


INDEX 


Sciatica,  65 
Scoliosis,  43 
Semi-lunar  cartilage,  displaced,  33, 

34 
Semi-membranosous  tendon,  14 
Separating  the  epiphysis,  18 
Shaft  of  ulna,  fracture  of,  23 
Sheath  of  head  of  biceps,  adhesions 

of  tendon,  27 
Shot  through  ankle  joint,  62 
Shoulder,  15 

adhesions  24,  25,  58 

method  of  manipulating,  27, 
28 
joint,  movement  of,  24,  65 
Simple  sprains,  41 
Sites  of  adhesions,  usual,  14 
Situation  of  pain,  determining,  23 
Smedley's,  65 

Soft  parts,  injury  of,  by  bullets,  58 
Space,  popliteal,  32 
Spinal  column,  manipulation  of,  42 
Spine,  caries  of,  42 

manipulation  of,  for  defect  or 
displacement  of  vertebra?,  43 
Splints,  59 
Sprain,  12 

hunting,  60 
knee,  63 
of  back,  44 
joint,  34 
sole  of  foot,  38 
thigh,  hacking,  60 
rider's,  41 

chronic,  1 5 
Sprained  joints,  moving,  9 

shoulder,  65 
Sprains,  8,  10,  41 

Stiffness  and  pain  after  adhesions,  44 
Strain  of  knee  joint,  lesions  from,  32 
Stretching,  muscle,  30 
Structures,  injury  to  muscular,  43 
rheumatic  inflammation  of  mus- 
cular, 43 
Styloid  process  of  ulna,  15 
Suggestion,  4 

Supination,  defective  and  flexion,  62 
pronation,  66 
and  pronation,  defective  actions 

of,  54 
and  pronation  of  hand,  faulty 

actions  of,  35,  36 
lost,  59 
Supinator  longus,  15 
Suppleness  to  elbow,  best  way  of 
restoring,  30,  31 


Suppositories,  morphine,  66 
Surgery,  homoeopathy  of,  9 
Swimming  for  back  and  hip  joint,  53 
Synovial  fluid,  inspissated,  35 

membrane,  nipped  fringe  of,  34 

membranes,  13,  22 

thickening,  63 
Synovitis,  22,  32,  34 

teno, 13 

Tarso-metatarsal  joint  adhesions,  60 

Tendo  achillis,  15,  37 

Tendon,  biceps,  25 

Tendons,  adhesions  connected  with, 

23 

of  muscles  and,  15 

contracted  adductor,  60 

round  malleoli,  adhesions  in,  37 
Tennis  calf,  15 

chronic,  15,  30 

overhand  serving  at,  25 
Teno  synovitis,  1 3 
Tenotomy,  16 
Thickening  of  capsule  of  joint,  58 

synovial,  63 
Thigh,  adductor  muscle  of,  15 

sprain,  60 
"Throwing  the  arm  out,"  25 
Thumb,  15 
Tibia,  32 

Tone  of  muscles,  condition  and,  24 
Trade  of  bonesetter,  hereditary,  5 
Trauma,  effects  of,  II,  12 
Traumatic  lumbago,  44,  45,  58,  61 

synovitis,  31 
Treatment  after-,  16,  33 
exercises  in,  47 

and  bonesetting,  II 

by  manipulations,  12 

electrical,  31 

manipulative,  of  coccygodynia, 

45 
of  arthritic  conditions,  40 
dislocations,  10 

of  injuries,  Wharton  Hood's, 
48,  49,  50,  51,  52 
Triceps  muscle,  29 
Tubby,  Mr.,  38 

Tubercular  trouble,  possible    pre- 
sence of,  42 
Turner,  6 
Twist,  17 

Ulna,  fracture  of  shaft  of,  23 

styloid  process  of,  15 
Usual  sites  of  adhesions,  14 


76 


INDEX 


Valgus  pads,  67 
Various  movements,  21 
Vertebras,  defect  or  displacement 

of,  43 
manipulation  of  spine  for,  43 
Vibration,  bicycle,  25 
Voluntary  action  of  muscles,  47 


Walking,  37 

Wasted  and  contracted  muscles,  20, 
28 
muscles,  method  to  remedy,  47 


Weight,  average  required,  55 
Weights,  20,  47 

and  pulleys,  exercise  by,  28 
Wharton    Hood's   "  Treatment   of 

Injuries,"  48,  49,  50,  51,  52 
Willett,  Mr.,  38 
Wound,  62 

gunshot,  61 
Wounded  Belgian,  61,  62 
Wrist,  accidents  to,  35 

annular  ligament  of,  15 

displacement,  66 

joint  adhesions,  64 


77 


COLUMBIA  UNIVERSITY  LIBRARIES  (hsl.stx) 

RD101R66C.1 

Modern  bonesettinq  for  the  medical  profe 

""' s" iiiii  ilium 


<i ■ ■"mull 


\ 


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